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AN 


INAUGURAL  ESSAY 

ON 

THE  BILIOUS  TYPHUS 

WHICH 

PREVAILED  IN  BANCKER-STREET  AND  ITS  VICINITY, 

»  IN  THE  CITY  OF  NEW- YORK, 

IN 

THE  SUMMER  AND  AUTUMN  OF  1820. 


BY  RICHARD  PENNELL, 

Honorary  member  of  the  Royal  Jennerian  Society,  London;  of  the  London  Vaccine 
Institution;  member  of  the  Medico-Chirurgical  Society  of 
the  University  of  the  State  of  New- York,  &c 


Le  temps  est  le  pere  de  la  verite. — Voltaire. 


$eto*§orfc: 

PUBLISHED  BY  E.  BLISS  AND  E.  WHITE,  102  BROADWAY. 

1821. 

J.  Seymour,  printer. 


OOUDMSIA^A ' 


kA 


This  Inaugural  Essay  was  submitted  to  the  Honourable 
the  Regents  of  the  University  of  the  State,  and  to  the  Trus- 
tees and  Professors  of  the  College  of  Physicians  and  Sur- 
geons of  the  City  of  New- York,  for  the  Degree  of  Doctor  of 
Medicine.     April,  1821. 


TO 


DAVID  HOSACK,  M.D.  L.L.D. 


FELLOW  OE  THE  ROYAL  SOCIETIES  OF  LONDON  AND  EDINBURGH  ; 


Professor  of  the  Theory  and  Practice  of  Physic  and  of  the  Institutes  of  Medicine,  in  the 
t  University  of  the  State  of  New- York;   President  of  the  New- York 

Historical  Society,  &c.  Sic.  Uc. 


Sir, 

The  many  disinterested  proofs  of  friendship  which  you  have 
manifested  in  my  behalf,  and  the  numerous  acts  of  kindness  and 
hospitality  which  I  have  received  at  your  hands,  will  never  be  effaced 
from  my  mind. 

The  unwearied  pains  and  solicitude  which  you  have  constantly 
evinced,  to  advance  and  facilitate  your  pupils  in  the  progress  of  their 
studies  ;  the  eloquent  and  indefatigable  zeal  with  which  you  are  wont 
to  impart  to  them  the  rich  and  ample  store  of  your  long  experience 
and  profound  researches  in  Medicine  ;  and,  above  all,  the  particular 
interest  and  care  which  you  have  condescended  to  bestow  upon  my 
own  education,  place  me  under  additional  and  lasting  obligations. 

Permit  me,  Sir,  to  inscribe  to  you  the  following  account  of  the 
Fever  of  Bancker-street,  as  an  humble  tribute  of  the  exalted  esteem 
which  I  entertain  for  your  benevolence  and  your  understanding,  and 
as  a  feeble  memorial  of  the  laudable  share  which,  in  your  official 
station  as  Resident  Physician  of  this  Port,  you  took  in  the  con- 
troversy to  which  this  subject  gave  rise. 

I  am,  with  the  greatest  respect, 

Your  obedient  and  humble  servant, 

RICHARD  PENNELL. 


TO 

PETER  S.  TOWNSEND,  M.  D. 

HONORARY   MEMBER   OF    THE    ROYAL    JENNERIAN    SOCIETY,   LONDON} 
AND   OF   THE   LONDON   VACCINE   INSTITUTION; 

Fellow  of  the  American  Geological  Society  at  ISTew-Haven,  and  of  the  Literary  and  Philo- 
sophical Society  of  New-York ;  late  Health  Commissioner  of  this  Port,  &c. 

Sir, 

I  know  of  no  person  to  whom  I  can,  with  more  propriety,  de- 
dicate these  pages,  than  to  yourself.  Exclusive  of  the  regard  in 
which  I  hold  your  talents,  and  of  the  particular  attentions  which  you 
have  shown  towards  me,  there  is  a  peculiar  reason  why  this  Disser- 
tation should  be  inscribed  with  your  name. 

For  it  was  by  the  exertions  of  yourself,  and  of  your  colleagues, 
as  Commissioners  of  Health,  that  the  character  of  the  Bancker-street 
Fever  was  first  placed  before  the  public  in  its  true  light,  divested  of 
the  errors  and  deceptions  with  which  it  was  attempted  to  be  obscur- 
ed, and  disarmed  of  those  appalling  features  by  which  it  was  endea- 
voured to  excite  a  panic  among  the  people. 

When  I  recall  to  mind  your  services,  in  protecting  the  reputa- 
tion of  this  metropolis  from  the  assaults  by  which  it  was  threatened 
within  ;  and  when  I  remember,  at  the  same  time,  the  acknow- 
ledged zeal  which,  as  Members  of  the  Board  of  Health,  you  all  ex- 
hibited in  guarding  us  from  foreign  infection  without,  though  it 
seemed  to  thicken  around  us  in  every  quarter;  I  cannot  but  depre- 
cate and  lament  that  vindictive  spirit  of  politics,  which,  regardless 
alike  of  talent  and  of  the  public  good,  has  removed  you  from  the 
situation  which  you  filled  with  so  much  credit  and  ability. 

I  am, 

With  sentiments  of  respect  and  esteem, 
Your  Friend, 

THE  AUTHOR. 


TO 

JOHN  W.  FRANCIS,  M.  D. 


Professor  of  Obstetrics  and  the  Diseases  of  Women  and  Children,  in  the  University  of  the 
State  of  New- York ;  Member  of  the  Medical  and  C  hirurgical  Society  of  London  ;  of  the 
Medico-Physical  Society  of  New-Orleans;  of  the  Massachusetts  Historical  Society;  of 
the  Literary  and  Philosophical  Society  of  New-York ;  of  the  Academy  of  Natural  Sci- 
ences of  Philadelphia ;  President  of  the  Medico-Chirurgical  Society  of  the  University  of 
the  State  of  New-York,  &c.  &c. 


THIS 

INAUGURAL  DISCOURSE 

ON    THE 

MUom  S&pgttg 

WHICH  PREVAILED    IN    BANCKER-STREET  AND  ITS  VICINITY, 
DURING   THE   SUMMER   AND   AUTUMN  OF   1820, 

IS  INSCRIBED, 

AS  A  MEMENTO  OF  FRIENDSHIP  AND  A  TRIBUTE 
OF  RESPECT, 

BY   HIS   SINCERE   FRIEND, 

AND  LATE  PUPIL, 

THE  AUTHOR. 


INTRODUCTION, 


It  may  be  thought  by  some,  that  the  subject  of 
the  following  Dissertation  has  been  already  exhausted 
by  the  numerous  writers  who  have  preceded  me  in 
the  controversy  to  which  it  has  given  rise.  My  in- 
tention is  not  to  involve  myself  in  the  disputes  of 
these  writers  ;  nor  do  I  pretend  to  have  had  sufficient 
experience  in  medicine,  or  to  be  possessed  of  that 
depth  of  penetration,  which  would  enable  rne  to  be- 
come an  umpire  in  a  case  of  this  kind. 

I  *have  endeavoured  only  to  collect  and  to  arrange 
the  materials,  which  this  investigation  has  brought  to 
light.  In  doing  this,  I  have  thought  it  not  taking 
too  great  a  liberty,  to  dispense  with  the  irrelevant 
matters  which  are  connected  with  this  discussion,  and 
to  confine  myself  only  to  the  broad  and  marked  out- 
lines of  the  subject,  and  to  those  facts  and  reasonings 
which  appeared  to  me  to  be  most  important. 

Unless  the  contributions  of  writers  are  occasional- 
ly booked  up,  it  is  difficult  to  know  what  has  been 
done.  Their  labours  will  prove  abortive,  and  our 
energies  will  be  wasted  on  ground  that  has  been  per- 
haps already  pre-occupied. 

If  I  have  devoted  myself  then  to  the  humble  task 
of  a  compiler,  I  hope  I  shall  not  be  thought  to  have 
been  engaged  in  a  useless  occupation ;  nor  shall  I  be 
thought   presumptuous,   I  trust,  if  in  pursuing  this 

B 


10 

course,  I  have  not  hesitated  sometimes  to  bring  to 
my  assistance  those  opinions  or  facts  which  I  have 
conceived  would  throw  additional  light  on  the  sub- 
ject under  consideration. 

I  hope  I  shall  be  pardoned  also  for  the  inferences 
or  conclusions  which  I  may  have  ventured  to  make, 
while  having  the  whole  ground  of  this  controversy 
Jaid  before  me. 


NOTICE. 


I  have  divided  this  Essay  into  three  parts. 
In  the  first,  I  have  endeavoured  to  show, 

1.  That  typhoid  symptoms  may  either  enter  pri- 
marily into  combination  with  other  diseases,  or  be  af- 
terwards superadded  to  their  symptoms. 

2.  That  bilious  symptoms,  also,  are  frequently 
found  blended  with  different  diseases,  more  or  less 
modifying  their  character,  but  not  so  far  as  to  give  to 
another  disease  a  distinctive  character,  or  one  which 
is  essentially  different  from  the  character  which  it 
would  possess  without  them. 

In  the  second,  I  have,  by  comparing  the  phenomena 
and  circumstances  attending  yellow  fever,  with  those 
of  the  Bancker-street  fever,  proved  that  the  two  dis- 
eases are  totally  irreconcilable ;  and,  in  illustration 
of  this  disagreement,  shown  that  similar  fevers  to  that 
of  Bancker-street,  are  by  no  means  a  novel  occur- 
rence, either  in  this,  or  other  countries  :  and, 

In  the  third,  I  have  shown  that  the  character  of 
the  Bancker-street  fever  was  proved  to  be  incom- 


12 


patible  with  that  of  yellow  fever,  not  only  by  the  sim- 
ple method  of  contrasting  those  two  diseases  by  them- 
selves, but  furthermore  by  comparing  the  Bancker- 
street  fever  with  three  remarkable  instances  of  a 
similar  fever  which  occurred  in  this  city,  and  with 
one  that  made  its  appearance  in  Philadelphia. 


DISSERTATION, 

Sfc. 


PART  I. 

1st.  That  typhoid  symptoms  do  frequently  traverse  the 
path  of  other  diseases,  and  become,  as  it  were,  engrafted 
upon  them  towards  the  termination  of  such  diseases,  is 
familiarly  known.  They  are  then  said  to  give  to  such  dis- 
eases a  typhoid  character  or  termination.  The  typhoid 
phenomena  form  a  stage  of  the  disease,  and  bear,  under 
these  circumstances,  the  same  relation  to  the  primary  dis- 
ease, as  well  as  to  the  whole  system,  that  the  gangrenous 
stage  of  phlogosis  does  to  the  local  inflammation,  and  to  the 
part  affected. 

Almost  every  disease,  of  which  we  have  any  knowledge, 
may,  and  does,  occasionally  pass  into  the  typhoid  stage  ; 
preserving,  however,  for  the  most  part,  its  diagnostic  cha- 
racter to  the  last.  We  see  this  exemplified  in  dysenteria, 
puerperal  fever,  tonsillitis  maligna,  and  in  several  cutane- 
ous diseases,  as  rubeola  nigra,  scarlatina  maligna,  variola, 
&c. 

As  the  phenomena  of  typhus  are  the  same,  though  in  a 
lesser  degree,  with  those  that  attend  the  decomposition  of 
animal  matter,  it  is  easily  explained,  why,  under  these  cir- 
cumstances, they  more  usually  announce  themselves  to- 
wards the  termination  of  a  disease,  rather  than  in  the  com- 
mencement. It  is  also  the  more  readily  understood  from 
this  fact  why  the  typhoid  stage  of  a  disease  is  so  often 
fatal. 

The  phenomena  of  typhus  do,  nevertheless,  form,  if  we 
may  be  allowed  the  expression,   binary  compounds  with 


14 

th>se  of  other  diseases.  The  phenomena  of  both  diseases 
ar<  then  allied  together  from  the  very  commencement,  al- 
though their  co-existenCe  might,  a  priori,  have  been 
thmght  incompatible.  The  disease,  in  such  cases,  derives 
its  name  from  the  elementary  diseases  which  have  united 
in  ts  production.  The  phenomena  of  typhus  associate  in 
th's  manner  with  those  diseases  which  affect  particular  or- 
gans, or  particular  sets  of  organs,  and  which  are  with  pro- 
priety termed  local  affections.  As  the  local  diseases  are 
limited  to  particular  parts  of  the  system,  their  phenomena 
,are  fewer  and  less  complex.  It  is  on  that  account,  per- 
haps, that  when  associated  with  typhus,  they  become  se- 
condary or  subordinate  to  this  disease,  so  that  the  affection 
of  the  whole  system,  ought,  in  our  opinion,  to  give  the  gene- 
ric, and  that  of  the  part,  the  specific  denomination  to  the 
disease. 

Typhus  puerperalis,  (puerperal  fever,)  as  it  occurs  in 
hospitals,  and  among  the  poor,  typhus  pneumonicus,  (perip- 
neumonia typhodes  of  Sauvages,)  and  typhus  dysentericus, 
(the  dysentery  of  camps,)  are  striking  examples  of  this  or- 
der of  diseases  ;  so  also  the  inflammatory  typhus  of  Arm- 
strong*, in  which,  according  to  him,  the  cerebral,  thoracic5 
and  abdominal  viscera,  are  respectively  implicated. 

But  inasmuch  as  typhus,  as  well  as  all  other  fevers,  are 
diseases  of  the  whole  system,  and*  therefore,  have  a  com- 
mon seat,  it  is  not  to  be  supposed,  that  the  same  functions 
could  be  under  the  influence  of  a  different  chain  of  morbid 
actions  at  the  same  time,  and  that  the  peculiar  phenomena 
of  these  fevers  would  readily  associate  together,  and,  at  the 
same  time,  preserve  their  distinctive  character  throughout 
their  course.  It  is,  on  the  other  hand,  more  presumablej 
that  one  or  the  other  set  of  phenomena,  would  take  the  pre- 
cedence, or  that  they  would  succeed  each  other ;  but  not 
co-exist  at  once.  Accordingly  we  find  that  all  fevers,  not 
commencing  as  typhus,  may  take  on  the  phenomena  of  tj- 

*  Practical  Illustrations  of  Typhus  Fever,  &c.  p.  24—68.    London,  1319. 


phus,  but  that  this  rarely  or  never  happens  until  every  ve- 
tige  of  the  primary  fever  has  been  obliterated,  and  its  courg 
nearly  terminated. 

2dly.  Bilious  symptoms  originate  from  a  morbid  conditio 
of  the  biliary  organs.  They  are,  therefore,  phenomena  f 
local  disorder,  or  derangement  of  those  organs.  The  on: 
affections  in  which  they  are  idiopathic,  and  to  which  the 
peculiarly  and  essentially  belong,  are  icterus  and  hepatiti 
They  are  occasionally  sympathetic  in  those  local  affection 
which  are  not  seated  in  the  biliary  organs  ;  and  also  in  ft 
vers — especially  in  remittent  fevers. 

The  remittent  fever  of  the  tropics  is  most  usually  disti; 
guished  from  the  ordinary  remittent  fever  of  colder  lat 
tudes  by  this  feature,  although  it  does  not  in  any  mamv 
change  the  pathognomonic  character  of  the  disease. 

It  has  been  thought  that  an  affection  of  the  biliary  c- 
gans  was  an  essential  part  of  the  character  of  yellow  feve; 
from  which  cause  that  disease  has  by  some  been  consid'/- 
ed  a  mere  grade  or  sub-species  of  bilious  remittent  fpvr. 
It  has  been,  however,  satisfactorily  proved,  that  the [yl- 
lowness  of  the  skin  and  eyes,  in  yellow  fever,  and  v(h;h 
has  been  mistaken  for  bilious  symptoms,  does  not  conem 
until  some  days  after  the  disease  has  been  formed ;  a^d;in 
some  instances,  not  until  after  death. 

"  The  yellow  colour  of  the  skin,  in  yellow  fever,  ecms 
to  be  more  owing  to  this  error  loci  of  the  globular  put  of 
the  blood,  than  to  the  over  absorption  of  bile.  Tfrs  co- 
lour does  not  appear  first  in  the  eye,  as  in  jaundi'S.  It 
may,  indeed,  be  produced  in  this  manner  in  the  skiflwith- 
out  any  suspicion  of  the  presence  of  bile.  This  isixem- 
plified  in  the  case  of  chlorotic  women,  and  other  cses  of 
chronic  weakness.  We  have  also  a  proof  of  it  in  te  Ec- 
chymosis  which  follows  upon  an  external  contusio.  In 
this  case,  the  red  part  of  the  blood  is  mechanicalljforced 
either  into  the  smaller  order  of  vessels,  or  into  the  eliular 
-membrane,  which  occasions  first  a  livid  appearand,  and, 


16 

i  the  course  of  the  recovery,  the  same  part  becomes  yel- 
lw;  probably  in  consequence  of  the  greater  part  of  it  be- 
ig  removed  by  absorption  or  otherwise;  for,  Sir  Isaac  New- 
tn  observes,  that  blood,  reduced  to  thin  lamina,  assumes  a 
jllow  colour.  Jt  is  observed,  by  Dr.  Rush,  that  in  some 
sbjects,  the  yellow  colour  did  not  come  on  till  a  few  mi- 
ntes  after  death ;  wrhich  seems  favourable  to  the  opinion 
( its  arising  from  something  in  the  mass  of  blood,  and  not 
bm  bile.  And  as  the  yellow  colour  first  shows  itself  about 
ie  neck,  and  sometimes  in  broad  spots  on  the  trunk  o[  the 
dy,  it  is  hardly  conceivable  that  such  partial  affections 
be  owing  to  an  effusion  of  bile,  which  would  necessa- 
act  equally  and  generally*."  Again,  "  Indeed  the  yel- 
ljvness  of  the  skin,  like  the  black  vomiting,  is  not  an  in- 
iable  symptom  of  this  fever,  [yellow  fever.]  Those  who 
a^  so  fortunate  as  to  recover,  seldom  have  it,  and  many 
dj  without  its  appearance.  Besides,  the  yellowness  alone 
leas  to  nothing  certain.  It  may  arise  from  an  inoffensive 
suision  of  bile,  as  well  as  from  a  gangrenous  state  of  the 
bllcdt."  The  yellowness  does  not  appear  on  the  skin  and 
ey:  until  the  second  stage,  (or  that  of  metaptosis,)  accord- 
in,  to  MoselyJ — according  to  Hosack,  Towne,  and  Hil- 
la^.not  until  the  third  day§.  And  the  following  fact,  stated 
ontle  authority  of  Sir  Gilbert  Blane,  puts  this  matter  to  rest, 
anmroves  that  this  yellowness  may  be  owing  to  an  external 
caul.  "  Some  instances  occurred  in  which  this  symptom 
(yeftwness)  was  contagious,  without  being  attended  with 
the  dier  characters  which  distinguish  this  disease,  [yellow 
fevei]  It  was  observed,  in  men  belonging  to  the  Royal 
Oak^vithout  any  symptom  of  malignity,  though  evidently 
infecous  ;  and  at  the  hospital,  it  was  known  to  spread 
frommen  affected  with  the  fever,  in  its  worst  form,  to 

*  Siflilbert  Blane  on  the  Diseases  of  Seamen — London,  1803,  p.  411 — 12, 
t  Meley  on  Tropical  Diseases — London,  1795 — p.  413. 
|  lb..  420. 

}  Hoick's  Nosology,  second  edition,  p.  191, — Towne,  p.  23,  and  Hillary, 
p.  149. 


17 

others  in  the  adjoining  beds,  without  being  accompanied 
with  any  malignant  symptom*." 

On  the  contrary,  if  the  phenomena  of  yellow  fever  be 
primarily  associated  with  any  particular  organ,  there  is 
every  reason  to  think  that,  that  organ  is  the  stomach,  and 
not  the  liver  or  gall  bladder.  "  In  the  course  of  this  dis- 
ease there  is  not  much  bile  in  the  intestines,  and  least  of 
all,  in  those  cases  that  are  most  violent,  and  prove  the  soon- 
est fatal.  In  those  whom  I  inspected  after  death,  there 
was  but  little  bile  even  in  the  gall  bladder.  Whether  this 
is  owing  to  a  scanty  secretion,  or  an  excess  of  absorption, 
I  will  not  pretend  to  determine,  but  I  should  rather  think 
it  owing  to  the  latter  cause.  In  cases  that  were  more 
protracted  and  less  desperate,  there  are  frequent  accu- 
mulations of  it,  as  appears  by  the  vomits  and  stoolst." 
Again,  "  In  the  course  of  this  disease,  though  there  are 
some  symptoms  common  to  inflammations  of  the  liver,  yet 
there  are  more  to  inflammations  of  the  stomach ;  and  none 
of  the  invariable  symptoms  which  distinguish  inflammations 
of  the  liver  from  all  other  diseases^." 

Bilious  symptoms  also,  are  not  unfrequently  blended  with 
the  phenomena  of  typhus  fever  5  but  they  do  not,  in  any 
degree,  obscure  the  character  of  the  disease.  Some  have 
thought  to  have  discovered  in  this  association  also,  the 
component  elements  of  yellow  fever;  from  whence  it  has 
been  called  by  them  bilious  malignant  fever.  By  Hillary, 
Putrid  Bilious  Fever.  The  best  authors,  however,  agree 
that  yellow  fever  is  far  more  of  an  inflammatory  than  a  ty- 
phoid affection.  We  have  already  seen  that  certain  symp- 
toms of  this  disease,  which  have  been  supposed  to  be  indi- 
cative of  a  morbid  condition  of  the  biliary  organs,  are  not, 
in  reality,  connected  with  any  derangement  of  those  organs, 
but,  in  all  probability,  owe  their  origin  to  some  other  cause 
than  that  of  the  bile.     Of  the  association  of  bilious  symp 

*  Diseases  of  Seamen,  p.  406 — 7. 

1  lb.  p.  406. 

t  Moseley  on  Tropical  Diseases,  p.  426. 

c 


18 

toms  with  typhus,  we  shall  soon  have  occasion  to  speak 
more  at  large. 

At  present,  we  will  illustrate  the  co-existence  of  typhoid 
and  bilious  symptoms,  by  instancing  bilious  remittent  fever, 
which,  from  the  unfavourable  circumstances  under  which 
it  sometimes  exists,  is  apt  to  terminate  in  typhoid  symp- 
toms. "  But  in  many  of  those  [cases  of  bilious  remittent 
fever]  that  arose  at  Jamaica,  little  or  no  remission  was  to 
be  perceived  ;  and  it  was  distinguished  from  the  ship  fever, 
by  the  bilious  vomitings  and  stools ;  more  violent  delirium 
and  head  ache ;  and  by  being  attended  by  less  debility. 
The  greater  tendency  to  the  continued  form  at  this  time, 
was  probably  owing  to  this  circumstance  ;  that  the  men  who 
were  exposed  to  the  land  air,  in  wooding  and  watering, 
were  then  exposed  also  to  such  causes  as  naturally  produce 
continued  fevers ;  such  as  infection ;  the  foul  air  of  the 
French  prizes  •,  intemperance,  and  hard  labour.  There 
was,  in  some  cases,  a  yellowness  of  the  eye,  and  even  of 
the  whole  skin,  but  without  the  other  symptoms  that  char 
racterize  the  yellow  fever,  properly  so  called,  while  others 
had  every  symptom  of  it. 

"  In  cases  that  proved  fatal,  the  symptoms,  for  some  time 
before  death,  resembled  very  much  those  of  the  fever  be- 
fore described,  [ship  fever,]  at  the  same  stage.  There  was 
either  coma  or  constant  delirium  ;  great  seeming  anguish ; 
the  mouth  and  tongue  very  dry,  or  with  only  a  little  ropy 
slime ;  a  black  crust  on  the  teeth ;  picking  of  the  bed- 
clothes, and  involuntary  discharges  of  urine  and  freces*." 
According  to  Dr.  Moseley,  an  extraordinary  putrid  bi- 
lious fever,  (thought  by  him  to  be  a  higher  grade  of 
the  bilious  remittent  fever  of  the  West  Indies,)  made 
its  appearance  among  the  troops  quartered  at  Jamai- 
ca, in  the  West  Indies,  in  the  latter  part  of  October, 
1 780.  k'  This  fever  came  on  with  sudden  loss  of  strength ; 
nausea,  clamminess  in  the  mouth  ;  the  eyes  were  dull  and 
tinged  with  bile  ;  they  were  also  sunk  in  the  head  :  there 

*  Diseases  of  Seamen,  p.  393 — 1. 


19 

were  besides  in  those  who  died,  even  from  the  first  attack 
of  the  disease,  several  other  marks  of  hippecratical  face, 
particularly  the  sinking  in  of  the  temples  ;  the  pulse  was 
low  and  quick ;  the  skin  was  moist ;  with  heaviness  in  the 
head ;  tension  and  uneasiness  in  the  abdomen,  and  great 
anxiety ;  the  skin  soon  became  of  a  deep  yellow  colour ; 
accompanied  with  coma,  cold  thin  sweats,  and  deep  labo- 
rious hickupping.  It  ended  on  the  second,  third,  or  fourth 
day,  in  death.  Some  of  the  gross  and  plethoric  died  soon 
after  being  attacked,  in  convulsions*."  Even  here  Dr. 
Moseley  considered  the  bile  as  "an  effect,  and  an  index  of 
the  state  of  the  liverf ,"  and  not  as  the  cause  of  the  disease. 
The  complete  success  which  attended  the  use  of  manna 
and  cream  of  tartar,  in  large  quantities,  together  with  the 
symptoms  of  the  disease,  shows  that  it  cannot  be  confound- 
ed with  yellow  fever. 

What  is  commonly  called  black  jaundice,  is  another 
strong  example  of  the  association  of  bilious  and  typhous 
symptoms. 

*  Tropical  Diseases,  p.  183 — 4 — 7. 

t  lb.  p.  186.  The  remittent  fever  of  Walcheren,  (as  described  by 
Wright,)  when  fatal,  terminated  usually  in  typhoid  symptoms.  See  Wright 
on  the  Walcheren  Remittent,  p.  10,  &c. 


21 


PART  II. 


I  shall  now  undertake  to  show,  from  a  comparison  of 
the  phenomena  which  attended  the  Bancker-street  fever 
with  those  of  Yellow  Fever,  that  those  two  diseases  are 
essentially  and  radically  different ;  and  that  the  opinion 
which  maintains  their  identity,  is  not  only  unsupported  by 
facts,  but  even  destitute  of  the  semblance  of  probability. 

There  are  many  circumstances  connected  with  the  his- 
tory of  a  disease,  which  have  nothing  to  do  with  its  symp- 
toms, but  which,  nevertheless,  are  inseparable  from  its  ex- 
istence, and  of  the  utmost  consequence  in  determining  its 
character :  such,  for  example,  as  the  climate,  country,  or 
locality  in  which  a  disease  occurs — the  season  of  the  year 
at  which  it  appears — the  class  or  description  of  persons 
among  whom  it  prevails — its  cause,  its  duration,  its  fatality 
— and  whether  it  be  epidemical,  endemial,  sporadic, 
&c.  &c. 

These  data  may  furnish  analogical  evidence  enough  to 
disclose  to  us  the  general  character  and  complexion  of  a 
disease,  without  the  aid  of  a  practical  acquaintance  with  its 
specific  phenomena  at  the  bedside  of  the  sick.  They  con- 
stitute a  body  of  information,  which,  for  the  most  part,  is 
obtained  without  difficulty,  but  which  is  not,  on  that  ac- 
count, the  less  desirable.  And  where  a  disease  makes  its 
appearance,  which  is  suspected  to  be  epidemical  in  its  ten- 
dency, or  endemical  to  the  district  in  which  it  occurs,  the 
data  of  which  we  are  speaking,  become  of  right  the  com- 
mon property  of  the  community,  and  the  legitimate  ground- 
work of  those  interesting  and  general  inquiries  in  relation 
to  the  public  health,  in  which  it  is  the  duty  and  province  of 


22 

every  citizen  to  participate,  whether  in  or  out  of  the  pro- 
fession. 

But  I  do  not  confine  myself  to  the  light  that  I  may  de- 
rive from  this  source.  My  opportunities  have  enabled  me 
to  make  a  personal  examination  of  the  disease  itself,  and 
to  become  familiarly  acquainted  with  its  actual  symptoms 
and  treatment. 

Although,  therefore,  I  have  the  liberty  of  employing  or 
not  employing  this  assistance,  I  waive  this  privilege  ;  and, 
in  order  that  I  may  not  subject  myself  to  the  imputation  of 
proceeding  upon  ex  parte  evidence,  will,  in  my  reasonings, 
make  use  of  all  the  proofs  which  have  been  put  in  my  pos- 
session. 

I  shall  first  contrast  the  two  diseases  in  those  points  m 
which  they  are  at  total  variance,  and  in  direct  contradic- 
tion— furnishing  demonstration  as  conclusive  as  can  be  ar- 
rived at  by  moral  evidence,  that  the  supposition  which 
maintains  their  identity  is  totally  unfounded. 

1.  The  fever  of  Bancker-street  was  confined  almost 
exclusively  to  blacks. — "  From  the  documents  obtained  by 
your  Committee,  it  appears,  the  number  of  blacks  affected 
by  the  epidemic  in  Bancker-street  and  its  vicinity,  to  the 
whites,  is  in  the  proportion  of  three  of  the  former  to  one 
of  the  latter ;  and  among  the  blacks,  the  disease  has  cer- 
tainly exhibited  a  greater  degree  of  intense  malignity  and 
fatality*." 

This  fact  is  also  confirmed  by  the  statement  of  the  Com- 
missioners of  Health,  in  the  following,  which  is  one  among 
the  numerous  and  argumentative  reasons  which  they  assign 
to  prove  that  this  fever  was  not  Yellow  Fever : — "  Because, 
notwithstanding  the  white  population  was  three  times  the 
number  of  coloured  persons  in  the  district  where  this  dis- 

*  Extract  from  the  Report  of  the  Committee  appointed  by  the  Medical  So- 
ciety of  the  City  and  County  of  New-York,  to  investigate  the  character  and 
causes  of  the  Fever  which  prevailed  in  Bancker-street,  p.  17 — published  De- 
cember, 1820. 


23 

ease  occurred,  yet  was  the  disease  almost  entirely  confined 
to  blacks.  While,  on  the  contrary,  in  yellow  fever,  blacks 
have  always  been  considered  to  be  less  susceptible  of  the 
infection  than  the  whites,  insomuch  that  coloured  persons 
have,  for  this  very  reason,  been  employed  in  nursing  the 
sick,  and  in  the  interment  of  the  dead*."  In  addi- 
tion to  the  testimony  of  the  Commissioners  of  Health, 
concerning  the  insusceptibility  of  negroes  to  yellow  fever, 
we  will  quote  the  authority  of  Sir  Gilbert  Blane,  in  his 
work  on  the  Diseases  of  Seamen.  "  It  has  been  said  that 
it  [yellow  fever]  never  attacks  either  the  female  sex  or 
blacks.  This  is,  in  general,  though  not  absolutely  true,  for 
I  knew  a  black  woman,  who  acted  as  nurse  to  some  men  ill 
of  this  disease,  at  the  hospital  at  Barbadoes,  who  died  with 
every  symptom  of  itf." 

The  committee  of  the  Medical  Society,  by  whom  we 
have  been  informed,  that  the  blacks  were  the  principal  vic- 
tims to  the  Bancker-street  fever,  in  summing  up  their  opi- 
nions on  this  disease,  positively  affirm  that  they  believe  it 
to  have  been  the  identical  yellow  fever  of  tropical  climates. 
"  We  do  not  hesitate  to  declare  our  conviction  of  the  iden- 
tity of Bancker-street  fever ',  with  the  malignant  fever  of  au- 
thors, from  Hippocrates  to  the  present  day,  and  the  yellow 
fever  of  tropical  climates,  and  our  own  harbours\."  Seeing 
the  obvious  difficulty  of  reconciling  the  character  which  they 
impute  to  this  fever,  with  the  description  of  persons  among 
whom  it  prevailed,  they  seem  to  have  imagined  that  they 
might  make  their  escape  from  this  dilemma,  by  asserting 
that  the  blacks  constituted  by  far,  the  greater  part  of  the 


*  Statement  of  Facts  relating  to  the  iate  Fever  which  appeared  in  Bancker- 
atreet  and  its  vicinity,  by  Drs.  Hosack,  Townsend,  and  Batley,  Commis- 
sioners of  Health.  January  22d,  1821,  Approved  of  and  published  by  orde  - 
of  the  Board  of  Health,  page  8. 

t  Page  4C4— 5. 

\  Page  30 — Report  of  the  Medical  Society  Committee. 


24 


inhabitants  of  the  district,  in  which  most  of  the  cases  of 
this  disease  occurred.  "  This  remarkable  circumstance 
has  induced  many  persons  to  believe,  that  the  Bancker- 
street  fever,  having  stricken  those,  who  were,  in  fact,  by  far 
the  most  numerous  inhabitants  of  that  district,  was  nothing 
more  than  an  ordinary  fever,  as  it  occurs  in  jails,  camps,  or 
hospitals  ;  or  else  being  a  distemper  peculiar  to  the  Afri- 
can race,  and  people  of  colour,  it  could  bear  no  resem- 
blance to  the  ordinary  bilious  remittents  of  our  cities,  and 
much  less  to  the  yellow  fever*."  But  the  actual  census  of 
every  house  in  this  district,  as  given  by  the  Commissioners 
of  Health,  furnishes  us  with  results  widely  different  from 
those  of  the  Committee  of  the  Medical  Society. 

"SKETCH  OF  BANCKER-STREET  AND  ITS  VICINITY. 

North. 


Population  of  the  District,  from  the  first  of  August  to  the. 
first  of  November,  182Q+. 

On  the  northernmost  side   of  Lombardy- 

street,  contiguous  to  the  lots  of  Bancker-     whites.     Biackr. 
street,  between  Catharine  and  Pike-streets       482       125 

On  the  southernmost  side  of  Bancker-street, 
between  Pike  and  Catharine-streets,  491       254 

On  the  northernmost  side  of  Bancker,  be- 
tween the  before-mentioned  streets,  513       162 

*  Report  of  the  Medical  Society,  p.  17. 

t  This  period  commences  before  any  cases  occurred. 


25 

On  the  east  side  of  Catharine,  and  west  of 
Pike-street,  and  that  part  of  Market-street, 
between  Lombardy  and  Bancker-streets,       246         21 

Total,   1732       562 
562 

Majoritywof  whites,  1 1 70* 

2.  This  fever  was  unaccompanied  by  black  vomit.  The 
exceptions  are  so  doubtful  that  we  have  not  thought  pro- 
per to  qualify  this  expression. 

"  Out  of  237  cases,  the  total  number  which  occurred  of 
this  disease,  no  symptom  presented  itself  different  from 
those  which  usually  attend  typhus  fever  under  similar  cir- 
cumstances. As  it  is  not  even  pretended  that  out  of  all 
this  number  more  than  eight  cases  have  occurred  of  black 
vomit,  some  of  which  are  stated  to  have  been  ascertained 
after  the  death  of  the  patient !  f  This  is  on  the  supposi- 
tion that  the  aforesaid  black  vomit  consisted  of  the  flaky  or 
coffee  ground  matter,  which  characterizes  yellow  fever  : 
bnt  of  this  there  is  no  evidence  givenj." 

It  is  so  well  established,  and  so  familiarly  known  to  even- 
person  who  has  ever  heard  of  yellow  fever,  that  this  disease 
is  peculiarly  distinguished  by  this  dreadful  symptom,  that 
it  would  be  useless  to  enumerate  authorities  in  support  of 
it.  So  characteristic  is  black  vomit  considered  by  the 
Spaniards  of  this  disease,  that  they  call  it  vomito  prieto, 
after  this  symptom. 

3.  Emetics  were  the  most  successful  remedies  employ- 
ed in  this  disease.     "  The  Bancker-street  fever  was  treat- 

*  Statement  of  the  Commissioners  of  Health  p.  13,  14, 
t  See  Report  of  the  Medical  Society,  p.  12,  13—26. 
1  Statement  of  the  Commissioners  of  Health*  p.  8,  9. 

D 


26 

ed  most  powerfully  and  successfully  by  emetics.     Here  is 
another  unheard  of  anomaly. — Emetics,  as  far  as  experi- 
ence has  gone,  are  precisely  the  very  things  that  we  are 
most  cautiously  to  avoid.     They  produce  the  most  disas- 
trous consequences,  aggravate  the  irritation,  and  retching  at 
the  stomach ;  bring  on  the  dreadful  black  vomiting,  and  soon 
hurry  the  unhappy  sufferer  out  of  existence.    On  the  other 
hand,  in  fevers  of  a  bilious  character,  the  very  reverse  is 
the  truth.  Emetics  are  the  surest  and  the  most  rapid  means 
of  cure*."    In  answer  also  to  some  inquiries  on  this  subject, 
made  to  Professor  Hosack,  we  have  had  the  satisfaction  of 
receiving,  from  him,  the  following  interesting  account  of 
the  treatment,  which  he  adopted  in  the  numerous  cases  of 
the  disease  brought  to  the  New- York  Hospital  : 

"  The  treatment  which  I  found  most  useful  in  the  cases 
of  the  bilious  typhus,  which  fell  under  my  care  during  my 
attendance,  last  autumn,  at  the  New- York  Hospital,  con- 
sisted, 

"'  1st,  In  the  early  use  of  emetics,  to  cleanse  the  stomach, 
and  disgorge  the  biliary  organs  which  were  overloaded  by 
an  inordinate  secretion  of  bile.     This  being  effected, 

"  2dly,  The  bowels  were  emptied  by  cathartics  of  salts  ; 
or  of  rhubarb  and  magnesia,  which  were  afterwards  occa- 
sionally administered  throughout  the  disease. 

"  3dly,  Attention  was  also  given  to  preserve  a  relaxed 
state  of  the  surface  of  the  body  by  the  use  of  the  spiritus 
mindereri ;  the  saline  draught  of  Riverius,  or  by  the  anti- 
monial  solution  :  these  were  aided  in  their  operation  by  fre- 
quently washing  the  body  with  tepid  vinegar  and  water, 
and  the  liberal  use  of  the  ordinary  diluent  drinks  ;  but,  in 
cases  showing  the  typhoid  character  in  its  most  formidable 

*  Remarks  on  the  Report  of  the  Committee  of  the  Medical  Society  of  this 
city,  on  "  The  Epidemic  Fever,  of  Bancker-street  and  its  Vicinity,  in  the 
Summer  and  Autumn  of  1820,"  p.  14 — 15.     Published  January,  1821. 


27 

shape,  drinks  composed  of  the  vegetable  acids,  as  lemonade, 
tamarind  water,  vinegar  whey,  were  prepared  ;  and  in 
those  cases,  whose  system  exhibited  great  exhaustion,  a 
preference  was  given  to  porter,  ale,  wine  whey,  and  vege- 
table nourishments,  viz.  tapioca,  sago,  arrow-root ;  render- 
ed grateful  by  the  addition  of  wine.  Snake  root  and  cha- 
momile tea  were  also  freely  given,  as  soon  as  the  febrile 
symptoms  abated.  Anodynes  were  also  prescribed  with 
great  benefit  in  those  cases  where  delirium  and  watchfulness 
occurred. 

"  In  cases  of  local  congestion  of  the  brain,  lungs,  or  ab- 
dominal viscera,  or  where  the  fever  continued  with  unusual 
obstinacy,  blisters  were  prescribed  with  the  most  beneficial 
effects. 

"  When  a  perfect  apyrexia  was  obtained,  bark,  bitters, 
and  the  mineral  acids,  were  had  recourse  to  ;  animal  food 
was  also  then  allowed,  but  during  the  progress  of  the  fever, 
this  was  altogether  inadmissible ;  even  in  the  form  of  soup, 
so  commonly,  but  improperly  given  in  the  typhoid  form  of 
fever. 

"  In  some  cases  where  the  disease  occurred  in  a  full  habit 
of  body,  attended  with  symptoms  indicating  local  inflam- 
mation of  the  thoracic,  or  abdominal  viscera,  or  exhibiting 
an  inordinate  pressure  on  the  brain,  bloodletting  was  em- 
ployed in  the  commencement,  but,  in  the  latter  stages,  the 
lancet  was,  in  no  instance,  called  for*.1' 

"  How  often,"  (says  Moseley,)  "  have  I  seen  and  lament- 
ed, the  effects  of  emetic  tartar,  given  to  remove  the  sup- 
posed cause  of  the  treacherous  symptom  of  vomiting  !  Even 
in  slight  degrees  of  fever,  [yellow  fever,]  in  the  West  Indies, 
in  young  plethoric  subjects,  newly  arrived,  the  stomach  has 
been  sometimes  destroyed  by  it.  Instead  of  removing  the 
irritating  sickness  of  this  fever,  or  exciting  diaphoresis, 
a  spasm  has  been  produced  in  the  stomach  ;  incessant  vo- 
miting, and  inflammation ;  the  vessels  of  the  thorax  and  head 

*  Extract  of  a  letter  from  Dr.  Hosack  to  the  author. 


28 

have  been  stifled  with  blood  ;  and  the  patient  has  vomited 
away  his  life." 

Again,  "  Vomits  are  never  to  be  given,  though  strongly 
advised  by  Towne ;  no,  not  so  much  as  warm  water,  re- 
commended by  Hillary*." 

It  is  admitted  that  gentle  emetics  have  now  and  then 
been  given  on  the  first  attack  of  yellow  fever,  but,  as  a 
general  practice,  they  are  universally  discountenanced. 

4.  "Notwithstanding  the  white  population  so  much  exceed- 
ed that  of  the  blacks,  yet  the  disease  has  been  almost  exclu- 
sively confined  to  coloured  persons,  and  particularly  to 
that  description  of  blacks  who  lived  in  crowded  apart- 
ments, especially  in  cellars,  and  who  were  depraved  in 
their  habits,  and  indigent  in  their  circumstances  :  inasmuch 
as  the  black  population  of  that  district  is  almost  exclusively 
composed  of  persons  of  that  description,  and  that  the  indi- 
gent and  worthless  class  of  whites  bear  but  a  very  small 
ratio  to  the  whole  number  of  white  inhabitants. 

"  Out  of  the  whole  number  of  blacks  in  this  district,  viz. 
562, — 119  lived  in  cellars,  of  whom  54  were  sick  of  the 
prevailing  fever,  24  of  whom  died  at  their  homes ;  while, 
out  of  the  remaining  number  of  black  inhabitants,  viz.  443, 
101  were  sick,  of  whom  46  died  at  their  homes.  From 
which  it  appears  that  out  of  443  who  were  better  lodged, 
only  101  were  sick  of  this  disease  ;  while  out  of  1 19  living 
in  unwholesome  cellars,  that  nearly  one,  half  were  taken  down 
with  the  disease,  and  that  nearly  one  half  of  that  number  died 
at  their  places  of  dwelling. 

"Out  of  the  whole  number  of  white  inhabitants  in  this 
district,  viz.  1732,  only  1 1  whites  died  out  of  32  sick. 

"  Those  persons  who  fell  victims  to  this  disease,  were 
scattered  over  the  district,  for  the  most  part,  in  insulated 
places,  and  the  disease  did  not  spread  from  one  side  to  the 
other  side  of  the  same  street,  nor  from  one  house  to  the  ad- 

*  lb.  p.  434. 


29 

joining  house,  nor  even,  from  the  cellars  to  the  other  parts 
of  the  same  house ;  by  which  it  is  apparent  that  this  fever 
was  not  entitled  to  the  appellation  of  an  epidemic ;  which 
is  furthermore  confirmed  by  the  fact,  that  those  persons, 
whether  black  or  white,  who  lived  a  becoming  and  regular 
life,  and  did  not  associate  with  the  dissolute  and  intempe- 
rate, almost  always  escaped,  although  inhabiting  an  adjoin- 
ing house,  and,  in  some  instances,  living  under  the  same 
roof  with  those  who  were  the  victims  to  it. 

"  The  total  number  of  sick  in  the  whole  district  ap- 
pears to  have  been,  as  nearly  as  we  can  ascertain,  about 
237  ;  of  which  the  greatest  number  sick  on  particular  lots, 
was — (See  Sketch.) 

"  At  No.  66  Bancker-street,  which  is  on  the  southern- 
most side  of  the  street,  and  at  the  western  extremity  of  the 
district,  and  near  Catharine-street — sick,  8  blacks. 

"  At  No.  95  Bancker-street — sick,  34  blacks  and  9 
whites  ; 

"  At  No.  85  Bancker-street — sick,  8  whites  ;  which  num- 
bers are  on  the  opposite  side  of  the  street  to  No.  66,  and 
near  the  middle  of  the  district. 

"At  No.  132  Bancker-street — sick,  22  blacks  and  2 
whites ;  which  is  at  the  eastern  extremity  of  the  district, 
and  near  Pike-street. 

"At  No.  43  Market-street,  between  Lombardy  and 
Bancker-streets,  6  whites  were  sick,  the  only  persons  sick 
in  the  street. 

"At  No.  85  Lombardy-street,  which  is  at  the  eastern- 
most extremity  of  the  district,  and  remote  from  all  the 
other  places  mentioned — here  9  blacks  were  sick,  and  1 
white. 

"  By  which  it  appears,  that  notwithstanding  there  are  1 48 
lots  in  this  district,  100  cases  (nearly  one  half  the  whole 
number  of  cases)  occurred  on  6  lots,  situated  in  different 
parts  of  the  district,  and  remote  from  each  other;  each  place 
constituting  a  distinct  focus  for  the  generation  of  disease. 


30 

"  In  that  section  of  Market-street,  embraced  between 
Lombardy  and  Bancker-streets,  and  which  is  the  centre  of 
this  district,  containing  1 27  whites  and  4  blacks,  living  on  1 3 
lots,  there  were  sick  6  whites,  who  all  lived  an  irregular 
life  in  confined  and  filthy  apartments,  in  the  back  build- 
ing of  No.  43  ;  while  no  other  person  in  that  street  had  the 
disease. 

"  On  the  southernmost  side  of  Bancker-street,.  be- 
tween Pike  and  Market-streets,  occupied  by  303  inhabit- 
ants, there  occurred  58  cases  ;  while  in  the  houses  directly 
opposite,  on  the  northernmost  side  of  the  street,  and  not  more 
than  60  feet  distant,  occupied  by  two  hundred  and  forty  in- 
habitants, of  whom  one  only  was  a  coloured  person  ;  out  of 
this  number  four  persons  only,  (whites,)  who  had  led  a  very 
intemperate  life,  sickened  and  died.  Two  of  them  lived 
at  No.  135,  a  neat  wooden  building,  occupied  altogether 
by  only  five  persons,  situated  in  the  rear  of  the  lot,  with  a 
clean  yard  of  at  least  80  feet  in  front. 

"Out  of  48  blacks,  living  in  10  cellars,  (viz.  No.  138, 
98,  96,  89,  87,  79,  84,  and  78  Bancker-street,  at  No.  53 
Lombardy-street,  and  No.  36  Pike-street,)  33  were  sick, 
of  whom  14  died  ;  while  out  of  120  whites,  living  immedi- 
ately over  their  heads,  in  the  apartments  of  the  same  houses, 
not  one  even  had  the  fever ! 

"  On  the  lot  95  Bancker-street,  34  blacks  and  9  whites 
were  sick  of  the  fever ;  on  the  lot  66  Bancker-street,  8 
blacks  were  sick ;  and  on  the  lot  85  Lombardy-street,  9 
blacks :  while  in  the  houses  immediately  adjoining  these  lots 
lived  sixty-one  whites  and  twenty-three  blacks,  who  being  all 
of  good  character,  and  having  no  intercourse  with  the  inter- 
mediate buildings,  all  escaped  the  disease. 

"  On  the  side  of  Lombardy-street,  next  to  Bancker- 
street,  and  between  Pike  and  Catharine-streets,  and  where 
the  lots  are  contiguous  to,  and  much  lower  than  those  of 
Bancker-street,  receiving  of  course  no  small  part  of  their 
putrefying  animal  and  vegetable  filth,  there  were  607  inha- 


31 

bitants,  (of  whom  125  were  blacks,)  and  1 9  only  sick ;  while 
on  the  contiguous  lots  of  Bancker-street  there  resided  740 
inhabitants,  of  whom  248  were  blacks.  Out  of  the  740} 
1 1 5  were  sick  of  the  fever,  of  whom  23  were  whites. 

"  After  the  most  diligent  inquiries,  we  have  not  been  en- 
abled to  discover  that  one  reputable  white  person  died  of 
this  disease,  with  the  exception  of  a  girl  recently  arrived 
from  the  country,  who  died  of  fever  in  the  latter  part  of 
October,  at  No.  130  Bancker-street.  But  on  the  other 
hand,  have  satisfactorily  ascertained  that  such  whites  only 
have  fallen  victims  to  it  as  were  in  extreme  poverty, 
crowded  in  small  fifthy  apartments,  and  who  led  a  profli- 
gate life,  or  associated,  or  lived  with  the  worthless  class  of 
coloured  persons. 

"  As  at  the  back  building  of  No.  43  Market-street,  al- 
ready spoken  of,  where  there  were  28  whites  of  low  charac- 
ter crowded  into  small  apartments,  living  in  the  most  filthy 
condition.     Out  of  this  number,  6  Were  sick. 

"  At  No.  85  Lombardy-street,  in  the  third  story,  were 
5  white  females,  and  a  black  man,  husband  to  one  of  them, 
all  of  whom  were  sick  of  the  fever. 

"At  No.  58  Bancker-street,  where  a  drunken  white 
woman  with  one  child,  lived  in  the  same  cellar  with  a  black 
woman,  all  of  whom  had  the  feyer. 

"At  No.  88  Bancker-street,  where  a  poor  distressed 
family  of  10  whites,  occupied  the  same  small  room,  and 
were  all  sick  with  the  fever. 

"  At  No.  89  Bancker-street,  in  the  front  cellar,  where 
a  white  woman  and  her  black  husband  lived  as  boarders  in 
a  black  family  consisting  of  6  persons,  all  of  whom  had  the 
fever,  and  4  of  the  blacks  died. 

"At  No.  95  Bancker-street,  where  30  blacks  and  6 
whites  lived  in  the  same  back  building,  and  all  were  sick  of 
the  fever. 

"At  No.  102  Bancker-street,  where  4  white  women 
kept  a  brothel  in  the  cellar,  and  had  constant  intercourse 


32 

with  negro  men.     Two  of  these  women  had  the  fever,  and 
one  died. 

"At  No.  124  Bancker-street,  where  a  white  woman 
and  her  black  husband  lived  together  in  the  front  cellar, 
and  the  black  man  died  of  the  fever. 

"Out  of  the  numerous  respectable  white  inhabitants  who 
have  continued  to  reside  in  this  district,  since  May  last, 
only  one  family  of  nine  persons,  (viz.  Mr.  Gifford's,  at  No. 
139  Bancker-street,)  removed  into  the  country  from  fear, 
but  returned  again  as  early  as  the  30th  of  September.  And 
not  an  instance  of  the  disease  took  place  in  any  of  these 
families. 

"Out  of  148  lots  in  this  district,  45  lots  were  occupied 
by  359  respectable  white  persons,  of  whom  not  one  indivi- 
dual was  sick  with  this  fever*." 

With  these  imposing  factsj'before  them,  the  Commission- 
ers justly  conclude,  that  the  disease  which  prevailed  in 
Bancker-street  and  its  vicinity,  bore  the  unequivocal  fea- 
tures of  a  genuine  typhus.  "  Because,"  say  they,  in  recapi- 
lating,  "  the  disease  prevailed  almost  without  an  exception, 
among  those  persons  who  were  excessively  intemperate,  in 
extreme  poverty ;  and  who  were  crowded  together  in  filthy 
and  confined  apartments ;  especially  in  low,  damp,  and  ill- 
ventilated  cellars:  a  combination  of  circumstances  which, 
it  is  universally  admitted,  produces  fever  of  a  putrid  or  ty- 
phoid character.  Which  is  furthermore  confirmed  by  the 
fact,  that  where  this  combination  of  circumstances  existed 
in  other  parts  of  the  city,  the  disease  made  its  appearance 
there  also.  Whereas  yellow  fever  makes  no  distinction  of 
persons,  and  is  equally  fatal  to  the  rich  and  the  poor. 

"  Because  those  persons  who  were  comfortably  accom- 
dated,  who  were  regular  in  their  lives,  and  did  not  enter 
into  the  infected  apartments  or  dwellings,  escaped  the  dis- 
ease ;  which  is  diametrically  opposed  to  the  known  laws  of 

*  Statement  of  the  Commissioners  of  Health,  p.  4,  5,  7,  14,  15,  16,  17- 


33 

epidemical  diseases:  and  it  is  well  known  to  every  inhabi« 
tant  of  this  place,  that  no  such  exceptions  were  observed  in 
those  portions  of  our  city  where  yellow  fever  has  prevail- 
ed.» 

So  also  the  author  of  the  Remarks  on  the  Report  of  the 
Medical  Society  Committee,  and  who  appears  to  have 
been  familiarly  versed  with  this  subject :  "  The  fever  of 
Bancker-street  commenced  with,  and  was  almost  exclusive- 
ly confined  to,  the  black  population  of  that  street,  though 
this  population  are,  according  to  their  own  topographical 
description,  '  mingled  promiscuously  in  the  same  apart- 
ments with  whites,  and  both  sexes,  of  all  ages.'  Where 
yellow  fever  prevails  to  great  extent,  all  fall  victims  to  it, 
black  and  white ;  but  whoever  heard  before  of  its  com- 
mencing its  attacks  upon  negroes,  and  confining  its  depre- 
dations to  that  particular  class?  On  the  contrary,  the 
blacks  are  notoriously  less  subject  to  it ;  *  but  in  this  fever,' 
say  the  Committee,  '  three-fourths  of  the  patients'  were  of 
this  class. 

"  Moreover,  the  description  of  blacks  whom  it  seized 
were  of  the  most  profligate  sort,  with  constitutions  vitiated 
and  broken  down  by  drunkenness  and  other  low  sensualities; 
for  it  is  such  persons  chiefly  who  inhabit  this  tainted  dis- 
trict, and  who  annually  become  the  victims  to  the  disease 
which  still  prevails  there.  But  yellow  fever  not  only  first 
attacks  the  whites,  but  those  of  them  who  are  most  pletho- 
ric and  robust,  of  rigid  fibre,  and  to  whom  the  common 
wants  of  life  are  easily  accessible.  This  the  Committee 
themselves  admit,  saying,  that '  the  most  robust,  and  seldom 
the  infirm,'  are  liable  to  it*." 

Now  it  is  well  known  that  yellow  fever  is  most  obnoxious 
to  those  who  are  of  firm  and  robust  fibre,  of  sanguine  tem- 
perament, of  inflammatory  diathesis,  and  of  a  plethoric  habit 
Hence  it  is  notorious  that  the  European  or  northern  man. 

*  Page  16, 

E 


34 

hewly  arrived  in  the  tropics,  is  the  common  victim  to  this 
disease.     We  will  quote  a  respectable  authority  on  this 
subject,  and  one  of  the  latest  which  occurs  to  us.    "  D'ou  il 
suit,   et  ^experience  le   confirme  chaque  jour,    que    les 
hommes  robustes  et  plethoriques  seront  plutot  victimes  de 
cette  maladie  que  les  hommes  faibles  et  cachectiques,  les 
jeunes  gens  plutot  que  les  adults  et  les  vieillards:  les  peuples 
du  Nord  plutot  que  ceux  du  Midi*."    M.  Gerardin  is  speak- 
ing here  of  what  he  calls  the  sporadic  non-contagious  yellow 
fever,  in  contradistinction  to  epidemic  contagious  yellow  fever. 
Those,   however,   who    have    pronounced    the   fever   of 
Bancker-street  the  identical  fever  of  the  tropics  will  not 
object  to  the  validity  of  M.  G's  testimony  on  this  point. 
Again,  "  Subjects  most  likely  to  be  attacked  by  the  ende- 
mial  causus,  are  the  florid,  the  gross,  the  plethoric ; — that 
sort  of  strong,  full,  youthful  people,  with  tense  fibres,  who, 
in  England,  (to  use  a  vulgarism.)  are  said  to  resemble  the 
picture  of  health.     In  short,  so  are  all  persons,  who  are  of 
an  inflammatory  diathesis,  and  do  not  perspire  freelyt." 
"  Hence,  it  is  not  strange,"  says  the  same  author,  "  that  sail- 
ors who  eat,  drink,  and  sleep,  so  much  at  sea,  and  use  no 
exercise,  being  always  of  a  gross  habit  of  body,  should  be 
attacked  with  it  more  than  other  new  comers  to  the  West 
Indies."     Therefore,  says  he,  the  French  call  this  disease 
Lafevre  matelotte.\ 

If  it  be  said  that  all  habits  and  constitutions  are  equally 
subject  to  yellow  fever,  the  question  still  remains  unan- 
swered, why  out  of  a  population  only  one-third  negroes, 
the  fever  of  Bancker-street  selected  more  especially  for  its 
victims  people  of  colour,  and  those  almost  exclusively, 
whose  constitutions  were  shattered  and  broken  down  by  in- 
temperance, and  other  irregularities. 

*  Page  51 — Memoires  sur  la  Fivere  jaune  Par.  N.  V.  A.  Gerardin,  now  of 
Paris,  late  Physician  at  New-Orleans — Paris,  1820. 
t  Moseley  on  Tropical  Diseases,  p.  417. 


35 

5th.  The  disease  continued  to  prevail  in  Bancker-street 
and  its  vicinity,  after  the  occurrence  of  repeated  frosts  and 
snows.     "  The  disease  has  continued  to  prevail  in  this  same 
district,  and  among  the  same  class  of  people,  notwithstand- 
ing the  prevalence  of  constant  cold,  and  of  repeated  frosts 
and  snows :  cases  having  been  received  into  the  New-York 
hospital  as  late  as  the  last  day  of  December,  1820,  and  at- 
tended with  the  same  symptoms  and  circumstances  ;  where- 
as, in  yellow  fever,  it  is  established  beyond  a  doubt,  that 
frost  invariably  and  effectually  extinguishes  the  disease*.'5 
6.  This  fever  became  contagious  in  freezing  weather, 
and  during  the  recurrence  of  frosts  and  snows.     So  that  it 
not  only  prevailed  after  the  cold  had  set  in,  but  actually  be- 
came contagious  under  this  change  of  season.     If  any  proof 
were  wanting  to  show  the  dissimilarity  of  this  disease  and 
yellow  fever,  or  if  we  were  deprived  of  every  other  proof 
but  this,  it  would,  of  itself,  resist  all  the  reasonings  which 
ingenuity  and  sophistry  combined,  could  bring  against  it. 
After  breaking  down  one  of  the  strongest  barriers  which 
separate  yellow  fever  from  all  other  diseases,  this  fever  of 
Bancker-street,  as  if  to  throw  its  character  in  yet  bolder 
relief,  mocks  and  countefeits  the  very  disease  whose  laws  it 
had  trampled  under  its  feet. 

"  Cases  of  this  disease  have  not  only  been  brought  to 
the  New-York  Hospital,  since  the  commencement  of  free- 
zing weather,  but  when  the  severity  of  the  cold  would  not 
admit  of  free  ventilation  in  the  wards  of  the  house,  the  dis- 
ease has,  in  conformity  to  the  laws  of  tjphus,  been  in  many 
instances  communicated  to  the  nurses  and  patients  of  that 
institution. ''t  As  appears  by  the  Report  of  the  Visiting 
Committee  to  the  Governors,  communicated  to  the  Board 
of  Health. 

"  During  the  months  of  September,  October,  and  No- 
vember, 131  patients,  ill  of  fever,  have  been  admitted  into 

*  Statement  of  the  Commissioners  of  Health,  p.  9,  10,     t  lb. 


36 

the  Hospital ;  of  this  number  23  have  died,  89  have  been 
cured,  and  1 9  remain  in  the  house  at  the  present  time.  Of 
the  above  number  5  died  within  24  hours  of  the  time  of 
their  admission,  and  three  others  within  48  hours  of  the 
said  time,  having  been  several  days  sick  previous  to  their 
admission. 

"  So  great  was  the  desire  of  the  Committee  to  comply  as 
much  as  possible  with  the  wishes  of  this  Board,  as  express- 
ed in  their  former  communication  to  the  Board  of  Health, 
that  after  having  filled  all  the  medical  wards  as  much  as  the 
Physician  deemed  prudent,  they  were  induced  to  allow 
some  of  the  medical  patients  to  be  removed  to  such  of  the 
surgical  wards  as  could  receive  them.  In  consequence  of 
this,  eight  of  the  surgical  patients,  and  a  nurse  in  one  of  the 
surgical  wards  took  the  disease,  of  whom  three  have  died ; 
one  of  their  best  nurses  also  has  for  some  time  been  in  a 
very  critical  situation,  but  is  now  considered  as  convales- 
cent. 

"  In  the  medical  wards  also,  two  of  the  nurses  caught  the 
disease  from  their  patients,  but  are  also  convalescent. 

"  While  the  weather  remained  pleasant,  so  as  to  enable 
the  nurses  and  attendants  freely  to  ventilate  the  different 
apartments,  the  Committee  continued  to  admit  all  fever  pa- 
tients that  were  brought  to  the  Hospital ;  but  at  the  com- 
mencement of  the  present  month,  when  it  was  improper  to 
ventilate  the  wards  as  freely  as  had  been  previously  done, 
fully  convinced  that  the  fever  prevailing  in  the  Hospital 
was  of  a  highly  malignant  and  infectious  kind,  the  Commit- 
tee thought  that  they  could  not  conscientiously  allow  any 
more  patents  labouring  under  typhus  fever,  to  be  admitted 
into  the  Hospital,  and  exercised  the  authority  vested  in 
them,  by  rejecting  them. 

"  In  stating  to  the  Board  that  they  think  the  fever  which 
has  prevailed  in  the  Hospital  is  of  an  infectious  kind,  they 
have  only  to  state,  in  support  of  the  opinion,  that  in  addi- 
tion to  its  being  communicated  to  the  nurses,  several  of  the 


37 

surgical  patients  who  caught  the  disease,  had  not,  for  a  con- 
siderable time,  been  out  of  their  wards  ;  and  until  the  re- 
moval of  the  medical  patients  into  them,  the  surgical  wards 
were  free  from  fever  of  any  kind.     The  Attending  and 
House  Surgeon  also  agree  in  opinion,  that  their  patients 
took  the  disease  from  the  medical  side  of  the  house. 
"  All  which  is  respectfully  submitted, 
"B.  W.  Rogers, 
"  John  B.  Lawrence, 
"Jonathan  Little, 

"  Visiting  Committee. 
"  New-York,  December  8, 1820*." 

When  proof  after  proof  crowd  thus  upon  our  senses,  we 
are  unable  to  withstand  their  force,  and  feel  lost  in  amaze- 
ment, that  persons,  possessing  ordinary  powers  of  intellect, 
could  have  possibly  distorted  or  misconceived  their  mean- 
ing. 

There  is,  however,  a  certain  obliquity  of  mind,  which, 
like  the  optician's  glass,  represents  objects  through  a  false 
medium,  tinging  the  richest  and  most  brilliant  c  lours  of 
the  landscape  with  a  pale  and  jaundiced  hue,  and  convert- 
ing the  noblest  proportions  of  figure  into  confusion  and  de- 
formity. 

I  shall  now  proceed  to  examine  those  more  unimportant 
and  minor  phenomena,  which,  regarded  by  themselves, 
might  lead  those  who  do  not  take  a  comprehensive  view  of 
this  subject,  to  suppose  that  a  certain  resemblance  or  agree- 
ment existed  between  the  fever  of  Bancker-street  and  yel- 
low fever  ;  but  which,  when  contrasted  with  the  prominent 
and  bolder  outlines  of  those  two  diseases,  are  shown  to  be 
utterly  fallacious,  and  not  entitled  to-  the  least  considera- 
tion. 

l.The  bilious  symptoms  which  accompanied  this  fever. 

*  Statement  of  the  Commissioners  of  Health,  p.  10,  26,  27,  28. 


38 

a  And  first  the  bilious  vomitings.     The  invasion  of  this 
disease   was   usually  accompanied  by  bilious   vomitings, 
showing  a  redundance  of  bile  in  the  stomach  and  biliary  or- 
gans.    This  vomiting  occurs  sometimes  in  yellow  fever. 
Many  contend,  however,  that  there  is  a  deficiency  of  bile 
in  yellow  fever,  and  Moseley,  who  is  an  advocate  for  the 
non-contagiousness  of  this  disease,  positively  says,  that  the 
vomiting  is  from  irritation,  and  not  from  plenitude  :.  "  the 
sickness  of  the   stomach,   and   disagreeable  taste  in  the 
mouth,  indicate  the  quality  and  not  the  quantity  of  the  of- 
fending secretions  :  the  vomiting  is  from  irritation  in  the 
stomach,  and  not  from  plenitude*."     But  we  relinquish  the 
right  of  making  use  of  this   opinion,  and  shall  go  on  to 
watch  the  progress  of  this  symptom.     Why  did  the  vomit- 
ings succumb  to  the  influence  of  emetics,  and  why  did  they 
decrease,  and  finally  become  entirely  suspended,  as  the 
disease  advanced,  and  for  a  day  or  two  before  death  ?    This 
almost  invariably  happened  in  every  one  of  the  numerous 
patients  that  fell  under  our  observation,  and  is  directly  the 
reverse  of  what  occurs  in  yellow  fever.     In  yellow  fever 
the  irritation  of  the  stomach  is  sometimes  not  distinctly 
perceptible  for  the  first  two  days  ;   but  it  universally  in- 
creases as  the  disease  goes  on,  until  it  ends  in  black  vomit- 
ing, and  destroys  the  patient.     Hence  the  distinction  adopt- 
ed by  Professor  Hosack,  in  his  Nosology,  between  bilious 
remitting  and  yellow  fever :  "  Remittens  Biliosa.  Generally 
preceded  by,  and,  in  the  first  stage,  attended  with,  great 
derangement  of  the  digestive  organs,  and  an  inordinate  se- 
cretion of  bile — the  skin  and  eyes  yellow,  urine  turbid — 
the  tongue  loaded  with  a  yellow  sordes  ;  breath  offensive  ; 
when  fatal,  terminating  in  typhus. 

"  Pestis  tropicus.  A  fever  commencing  suddenly,  with  se- 
vere pain  in  the  head,  back,  and  limbs ;  remarkable  redness 
of  the  eyes  ;  unless  relieved  frequently  about  the  third  day, 
succeeded  by  a  yellowness  of  the  skin  ;  accompanied  with 

*  Tropical  Diseases,  p.  434. 


39 

great  anxiety,  and  distress  in  the  region  of  the  stomach 
which  generally  terminates  in  the  vomiting  of  black  matter 
resembling  coffee  grounds ;  when  fatal,  usually  proves  so 
within  seven  days  ;  in  a  foul  atmosphere  contagious."* 

b.  The  yellowness  of  the  skin  and  adnata.  These  symp- 
toms too  were  simultaneous  in  their  appearance  and  move- 
ments, with  the  bilious  vomitings.  All  showing  that  their 
source  and  seat  was  intimately  connected  with  the  condi- 
tion of  the  biliary  organs.  Moreover,  the  colour  of  the 
eyes,  which  was  so  distinctly  marked,  was  the  bright  golden 
hue  of  jaundice,  and  not  the  dark  muddy  tinge  of  yellow 
fever.  Nor  does  the  yellowness  in  yellow  fever,  usually 
appear  as  we  have  already  seen,  until  the  disease  is  form- 
ed and  half  through  its  course,  and,  in  some  instances,  ac- 
cording to  Dr.  Rush,  not  until  after  the  death  of  the  pa- 
tient!. In  yellow  fever  it  is  obviously,  as  the  best  writers 
remark,  an  effect,  and  not  a  cause  of  the  disease. 

And  Towne  has  gone  so  far  as  to  say  that  the  yellowness 
is  even  indicative  of  a.  favourable  crisis.  "  The  regular  cri- 
sis, therefore,  of  this  fever,  generally  discovers  itself  by  a 
suffusion  of  the  bile  all  over  the  surface  of  the  body,  about 
the  third  day.  The  saffron  tincture  is  frequently  observed 
in  the  space  of  twelve  hours  after  the  attack,  if  you  care- 
fully inspect  the  coats  of  the  eyes,  and  the  sooner  it  ap- 
pears the  more  encouraging  is  the  prognostic,  if  the  inten- 
tion of  nature  be  not  prevented  by  the  preposterous  use  of 
cordials  and  alexipharmicsj." 

c.  The  yellow  fur  on  the  tongue  constantly  attended  the 
other  bilious  symptoms.  Now  it  is  well  established  that  the 
state  of  the  tongue  is  by  no  means  an  infallible  symptom  in 
yellow  fever,  and  that  in  one  half  the  cases  at  least,  it  is  des- 
titute of  any  colour,  and,  in  many,  without  the  slightest  far 
upon  it.     In  the  fever  of  Bancker-street,  however,  it  was 

*  Hosack's  Nosology,  second  edition — New- York,  1821,  p.  186,  191. 

t  See  also  Burnet  on  the  Mediterranean  Fever,  p.  19  and  492. 

%  Towne  on  the  Diseases  of  the  West  Indies — London.  1726,  p.  23.  24 


40 

not  only  yellow,  but  from  the  beginning,  covered  in  the 
middle  and  towards  its  base,  with  a  yellowish  brown  sordes. 
As  the  disease  advanced  it  became  dry  and  chapped ;  which, 
taken  in  connexion  with  the  sunken,  soft,  and  unresisting 
pulse,  and  the  other  symptoms,  were  quite  sufficient  to  esta- 
blish the  typhoid  character  of  the  disease.  I  saw  this  ex- 
emplified in  six  or  seven  remarkable  instances  of  the  dis- 
ease, in  which  every  symptom  was  clearly  and  boldly  de- 
veloped. The  hectic  flush  on  the  cheeks,  which  I  have  al- 
ways observed  to  be  one  of  the  most  faithful  attendants  upon 
the  parched  and  scaly  tongue  of  typhus,  was  also  present 
in  these  cases. 

It  is  obvious,  therefore,  that  although  bilious  symptoms 
were  present  in  this  disease,  they  cannot,  when  taken  in 
connexion  with  the  circumstances  which  attended  them,  be 
at  all  explained  on  the  supposition  that  the  fever  of  Bancker- 
street  was  yellow  fever.  If  the  disease,  however,  be  con- 
sidered to  have  been  typhus,  all  the  difficulties  and  anoma- 
lies which  perplex  us  in  this  part  of  our  inquiry,  immedi- 
ately vanish.  Bilious  symptoms  do  frequently,  we  shall 
find,  become  blended  with  typhus  fever,  particularly  in  the 
tropics,  or  during  the  hot  season  of  temperate  climates,  and 
in  the  must  malignant  form  of  this  disease,  or  that  which  is 
seen  in  ships,  jails,  hospitals,  camps,  manufactories,  and 
other  places  where  great  numbers  are  crowded  together 
in  i!l-ventilated  apartments. 

Sir  Gilbert  Blane,  in  describing  the  infectious  ship  fever, 
enumerates  bilious  symptoms  as  a  characteristic  modifica- 
tion of  this  low  form  of  typhus,  as  it  appears  in  the  tropics. 
"  The  fever  we  are  treating  of  differs  also  from  the  spora- 
dic nervous  fever  of  England,  and  from  most  others  of  the 
continued  kind,  in  being  attended  with  a  more  copious  secre- 
tion of  bile,  which,  when  thrown  up,  is  generally  green,  or 
as  it  is  otherwise  called,  of  a  porraceous  colour.  This  symp- 
tom takes  place  in  all  climates ;  but  it  is  more  remarkable 
in  a  hot  climate  as  might  be  expected*."  Again,  "  It  some- 
*  Diseases  of  Seamen,  p.  349. 


41 

times  happens  that  men  under  the  influence  of  this  infec- 
tion, [ship  fever,]  are  more  apt  than  others  to  he  affected 
with  symptoms  peculiar  to  the  climate,  upon  their  first  ar- 
rival*." 

Thus  "the  increase  [in  1783]  of  fever  in  the  old  squads 
ron,  was  owing  to  two  causes.  One  was  the  importation  of 
new  raised  recruits,  brought  from  England  by  some  ships 
that  arrived  in  the  beginning  of  January.  These  were  dis- 
tributed to  such  ships  as  stood  in  most  need  of  men  ;  and  be- 
ing very  dirty  and  ill  clothed,  were  likely  to  harbour  in- 
fection. They  were  evidently  the  cause  of  sickness  in  the 
Warrior  and  Royal  Oak,  for  these  ships  were  before  that 
time  healthy,  and  the  fever  began  with  these  strangers,  and 
spread  amongst  the  former  crew.  It  is  remarkable  that  the 
ships  that  brought  them  from  England  were  not  affected  by 
them.  It  was  caught  in  the  Royal  Oak  from  six  men  that 
came  from  England  in  the  Anson,  which  men,  though  first 
put  on  board  the  Namur,  communicated  no  fever  there, 
having  been  kept  separate  from  the  rest  of  the  men  ;  but  be- 
ing sent  to  the  Royal  Oak,  they  were  themselves  first  taken 
ill  with  a  fever,  which  afterwards  spread  to  about  thirty  of 
the  other  men.  What  was  singular  in  this  fever  was,  that 
the  eyes  and  skin  of  all  that  were  affected  by  it,  became 
yellow,  though  without  any  particular  malignancy,  for  only 
two  died  on  board  and  one  in  the  hospital.  There  was  one 
whose  complaint  was  so  slight  as  never  to  confine  him  to 
his  bedt." 

This  gradation  in  the  violence  of  the  disease  was  parti- 
cularly noticed  also  in  the  Bancker-street  fever.  The 
same  particular  laws  of  contagion  seem  also  to  have  belong- 
ed to  both  diseases,  judging  by  the  numerous  facts  which 
have  been  already  stated  in  the  previous  part  of  this 
essay  in  illustration  of  the  circumstances  under  which  the 
fever  of  Bancker-street  became  communicable. 

As  I  have  so  often  had  recourse  to  the  writings  of  Sir  Gi3- 

*  lb.  p.  350.  t  lb.  p.  147—8. 

F 


42 

bert  Blane,  it  may  riot  be  thought  irrelevant  to  mention, 
that  he  was  physician  of  a  fleet  of  upwards  of  40  sail  of  the 
line,  under  the  command  of  Admiral  Lord  Rodney,  and 
containing  more  than  22,000  seamen  and  marines.  This 
fleet  was  employed  in  cruising  in  the  West  Indies,  in  1780, 
1,  2,  and  3,  and  there  never,  perhaps,  has  occurred  a  simi- 
lar opportunity  of  testing  the  effects  of  climate  upon  the  hu- 
man constitution,  on  so  grand  a  scale,  and  where  the  expe- 
riment was  so  completely  under  the  control  of  the  indivi- 
dual who  surperintended  it.  Sir  Gilbert  did  not  neglect  to 
avail  himself  of  these  advantages,  and  his  authority  on  Sea 
Epidemics,  and  on  the  modifying  influence  of  climate,  upon 
these,  as  well  as  other  diseases,  is  of  the  very  highest 
kind. 

According  to  Sir  James  McGrigor,  typhus  made  great 
havoc  among  the  British  troops  in  the  Spanish  peninsula, 
in  the  year  1812;  particularly  at  the  hospitals  of  Ciudad, 
Rodrigo,  and  Viseu.  At  the  latter  place  the  disease  was  at- 
tended with  a  yellowness  and  jaundiced  state  of  the  skin  ;  in 
all  of  which  it  ended  in  death. — In  one  of  these  cases  the 
gall  bladder  was  found  distended  with  bile,  but  none  was 
perceived  in  the  duodenum*. 

Another  case,  directly  in  point,  is  given  on  the  authority 
of  the  Commissioners  of  Health  :  "  A  high  grade  of  typhus, 
attended  with  bilious  symptoms,  has  oftentimes  occurred  in 
this,  as  well  as  in  other  countries,  at  the  same  season  of  the 
year  at  which  this  disease  prevailed.  And  a  very  remark- 
able instance  of  it  took  place  in  the  year  1801,  when  many 
vessels,  unusually  crowded  with  passengers,  arrived  at  this 
port,  from  Ireland,  during  the  summer  and  autumn.  Out 
of  at  least  750  patients,  who  were  admitted  into  the  marine 
hospital,  almost  all  of  whom  were  sick  of  this  disease, 
nearly  300  died,  besides  a  great  number  who  perished  on 

*  See  Sketch  of  the  Medical  History  of  the  British  Armies,  in  the  Peninsula 
of  Spain  and  Portugal,  &c.  by  Sir  James  McGrigor — London,  1816 — p.  31, 
32,  33,  34. 


43 

their  passage.  The  disease,  which  was  simply  typhus  on 
board  the  ships  which  first  arrived,  became,  as  the  vessels 
progressively  arrived  later  and  later  in  the  season,  (from 
the  same  ports — chiefly  from  Belfast,)  combined  with  bili- 
ous symptoms,  which  acquired  more  and  more  intensity  as 
the  season  advanced*." 

Again,  "  a  fever  precisely  analogous,  in  all  its  particulars, 
to  that  of  Bancker-street  broke  out  nearly  at  the  same  time 
in  the  suburbs  of  this  city,  at  the  penitentiary  at  Bellevue." 
"  During  the  months  of  July,  August,  and  September,  and 
the  early  part  of  October,  (says  the  physician  who  attend- 
ed this  institution,)  there  occurred,  at  that  establishment, 
a  disease  exhiting  many  characters  of  the  typhus  gravior, 
jail,  or  hospital  fever,  accompanied  with  bilious  symptoms, 
especially  among  the  blacks  ;  such  as  yellowness  of  the  eyes 
and  skin,  epigastric  distress,  in  some  instances,  so  great  as 
to  render  the  slightest  pressure  intolerable!." — We  shall 
have  occasion  to  refer  to  this  again. 

2.  The  vessels  of  the  eye,  in  many  cases,  were  tinged 
with  red  blood,  as  in  yellow  fever.  But  this  was  a  symptom 
which,  (if  we  may  be  allowed  to  treat  this  subject  with  levi- 
ty,) the  patient  had  had  for  many  years,  for  it  was  only  ob- 
served in  those  who  were  well  known  to  be  inveterate 
drunkards. 

Admitting,  however,  that  it  was  more  frequently  present 
than  we  are  willing  to  allow,  the  ablest  writer  who  has  ever 
treated  of  typhus,  (Dr.  Armstrong,)  informs  us,  that  it  is  a 
very  common  symptom  of  that  disease.  In  the  inflammatory- 
typhus,  where  the  brain  is  involved  in  inflammation,  there 
are,  among  other  symptoms,  according  to  this  author, 
"  Deep  pulsating  pain  in  the  head;  increased  heat  of  the 
temples,  forehead,  and  hairy  scalp ;  throbbing  of  the  carotid- 
arteries  ;  tinnitus  aurium  ;  redness  and  morbid  sensibility  of 

*  Statement  of  the  Commissioners  of  Health,  p.  9. 
i"  Report  of  the  Medical  Society  Committee,  p.  11. 


44 

the  eyes  ;  and  more  or  less  disorder  in  some  other  of  the  ex- 
ternal senses*." 

Again,  "  But  sometimes  acute  inflammation  of  the  brain, 
in  typhus,  is  not  to  be  discriminated  by  the  succession  of 
symptoms  above  described.  In  such  cases  it  is  mostly  to 
be  recognised  in  the  beginning  by  a  glary  bloodshot  eye  ;  a 
contracted  pupil ;  an  agitated  expression  of  the  counte- 
nance!," &c 

This  redness  of  the  eye  is  also  sometimes  a  prominent 
symptom  in  the  attack  of  the  congestive  form  of  typhus,  of 
this  author.  "  The  eye  is  occasionally  glary  and  vacant, 
without  redness ;  but,  at  other  times,  it  is  heavy,  watery,  and 
streaked  with  blood,  as  if  from  intoxication,  or  want  of 
sleepj." 

3.  The  irritation  at  the  pit  of  the  stomach.  This  symp- 
tom was,  by  no  means,  constant,  and  was  often  confound- 
ed with  the  genuine  inflammation  of  the  stomach,  which 
accompanies  yellow  fever.  In  a  great  number  of  instances, 
it  was  a  simple  irritation,  attributable  entirely  to  the  pre- 
sence of  bile,  and  other  acrid  secretions,  in  the  stomach  ; 
the  proof  of  this  we  have  in  the  fact  that  emetics  removed, 
or,  at  least,  mitigated  this  symptom,  and  that  it  declined  with 
the  bilious  vomitings.  In  a  number  of  instances,  I  ascer- 
tained that  the  irritation  was  not  confined  to  the  pit  of  the 
stomach,  but  extended  over  the  whole  abdomen,  and  down 
to  the  pubis.  It  was  in  these  cases,  no  doubt,  the  same  ir- 
ritation, or  sub-acute  inflammation,  which  almost  always 
affects  the  external  muscles  and  integuments  of  the  whole 
body  in  typhus  fever  ;  producing  a  universal  soreness,  and 
leading  the  hasty  observer  to  suspect  that  the  pain  is  deep 
seated,  and  owing  to  the  inflammation  of  some  internal  or- 
gan. We  thus  see  that  this  mysterious  epigastric  affection  ; 
this  distress  at  the  prascordia,  which  has  been  dwelt  upon 
Iby  so  many  as  a  pathognomonic  evidence  of  the  identity  of 
this  disease  with  yellow  fever,  may,  in  a  great  number  of  in- 

*  Armstrong  on  Typhus,  &c.  p.  29.        t  lb.  p.  29,  40.        J  lb.  p.  76, 


45 

stances,  be  satisfactorily  accounted  for,  without  the  neces= 
sity  of  this  supposition.  But  we  have  yet  stronger  testi- 
mony. The  irritation  at  the  epigastrium,  may,  for  argu- 
ment's sake,  be  admitted  to  have  been  actually  present  in 
a  number  of  cases.  We  will  also  allow  that  it  indicated  the 
presence  of  a  degree  of  inflammation  in  the  stomach,  and 
we  will  now  show  that  all  this  may  have  occurred,  and  yet  be 
entirely  reconcileable  with  the  position  for  which  we  have 
contended  from  the  outset,  that  the  fever  of  Bancker-street 
was  not  yellow  fever,  but  typhus. 

Epigastric  irritation  denoting  inflammation  of  the  inner 
surface  of  the  stomach,  and  ending  repeatedly  in  gangrene, 
suppuration,  ulceration,  and  even  perforation  of  the  coats 
of  this  organ,  is,  according  to  Armstrong,  often  complicated 
with  typhus  fever.  Even  where  the  brain  and  its  invest- 
ing membranes,  only  are  involved  in  inflammatory  typhus, 
there  are,  according  to  him,  "  generally  transient  pain  in 
the  limbs  ;  oppression  of  the precordia  ;  torpidity  of  the  intes- 
tines ;  uneasy  respiration,  attended  with  heavy  sighs  ;  nausea, 
retching,  or  vomiting  augmented  on  motion*,"  &c. 

-Again,  "  when  an  acute  inflammation  invades  the  lining- 
of  the  stomach  or  bowels  in  typhus,  it  is  generally  denoted 
by  some  degree  of  pain  and  tenderness,  by  the  stools  con- 
taining unnatural  mucus,  a  coagulable  lymph,  with  or  with- 
out some  admixture  of  blood,  by  unusual  flatulence,  by  a 
short  hurried  respiration,  by  an  anxious  countenance,  under 
pressure  of  the  affected  region,  by  great  prostration  of  strengh, 
by  a  small  quick  pulse,  and  by  the  patient  lying  prostrate 
on  the  back,  with  the  knees  mostly  elevated,  and  the  fee^ 
drawn  upwards.  If  this  acute  inflammation  be  in  the  inte- 
rior of  the  stomach,  or  of  the  upper  portion  of  the  intes- 
tines, nausea,  retching,  or  vomiting,  is  generally  present 
with  a  sense  of  heat,  and  an  intense  desire  for  cold  drinks  : 
but  if  the  inflammation  be  seated  in  some  inferior  portion 

*  Armstrong  on  Typhus,  p.  28, 


46 

of  the  gut,  and  particularly  in  the  colon,  these  symptoms 
may  all  be  absent*.'' 

Those  who  have  been  conversant  with  the  fever  of 
Bancker-street,  will  not  fail  to  recognise,  in  all  the  above 
symptoms,  a  great  number  of  those  which  occurred  in  cases 
of  that  disease. 

This  irritability  of  the  precordia  is  a  symptom  also  of 
the  congestive  typhus  of  Armstrong.  "  The  pulse  is  low, 
struggling,  and  variable  ;  the  stomach  irritable],"  &c. 

A  disease  similar  to  that  described  by  Moseley  |,  also 
prevails,  according  to  Curtis,  in  the  East  Indies.  He  de- 
scribes it  under  the  name  of  bilious  fever  and  flux:  it  dif- 
fers materially  from  the  putrid  bilious  fever  of  Moseley  in 
its  duration.  The  fever  he  considers  altogether  symp- 
tomatic of  the  flux,  and  the  latter  he  considers  as  produced 
and  maintained  by  a  superabundant  and  vitiated  condition 
of  the  bilious  secretion,  evinced  in  the  beginning  by  the 
nature  of  the  discharges,  and  the  disorder  induced  on  the 
alvine  functions.  The  fever  disappeared  the  moment  the 
bowel  disorder  was  corrected,  and  in  proportion  to  the 
quantity  of  bile  discharged  by  stool.  Evacuants  here  too 
were  found  of  the  utmost  importance  ;  and,  as  in  the  fever 
of  Moseley,  the  combination  most  effectual,  and  at  the  same 
time  most  acceptable  to  the  stomach,  was  cream  of  tartar 
and  manna.  Emetics  were  not  indicated,  and  did  harm. 
There  was  not  more  }ellowness  of  the  skin,  eyes,  or 
urine,  than  commonly  accompanies  all  the  India  diseases 
where  the  liver  or  its  secretion  is  concerned.  The  at- 
tack was  sudden  and  severe  in  many  cases,  and  attended 
with  a  high  degree  of  fever ;  the  pulse  sometimes  hard,  but 
always  very  frequent ;  tongue  and  skin  dry,  hot,  and  parch- 
ed, and  the  patient  very  soon  became  delirious.  In  a 
more  advanced  state,  the  tongue  became  thickly  covered 
with  a  yellow  crust ;  with  a  small  and  quick  pulse  ;  prostra- 

*  Armstrong,  p.  51 — 2.  t  lb.  p.  76.  %  Seep.  18  of  this  Essay. 


47 

lion;  pale,  sunk,  or  sallow  countenance ;  great  heat,  pain, 
tension,  and  tumour  of  the  abdomen  ;  fulness  at  the  pit  of  the 
stomach,  and  pain  and  tenderness  there  on  pressure  ;  retch- 
ing, vomiting,  and  great  irritability ;  now  and  then  with 
wild  frenzy  and  delirium ;  and  sometimes  with  cold  extre- 
mities, hickup,  cold  sweats,  and  death.  Inflammation  and 
gangrene  of  the  intestines  soon  came  on.  Generally  conti- 
nued when  mild  from  two  to  three  weeks ;  at  other  times 
to  a  much  longer  period.  There  were  none  of  the  symp- 
toms of  hepatitis. 

The  author  remarks,  that  typhus,  synochus,  synocha, 
scarlatina,  and  erysipelas,  were  unknown.  It  is  very  evi- 
dent, however,  that  the  fatal  and  and  more  alarming  cases 
of  the  disease  terminated  in  typhoid  symptoms;  and  that 
the  irritability  of  the  precordia  was,  particularly  at  this 
time,  one  of  the  most  prominent  and  formidable  symptoms. 
Epigastric  irritation,  therefore,  may  occur  to  an  intense 
degree,  among  an  assemblage  of  symptoms  which  bear 
much  less  resemblance  to  those  of  the  yellow  fever,  than 
to  the  disease  treated  of  in  this  essay.  And  if,  as  Curtis  seems 
to  believe,  this  disease  was  entirely  produced  by  an  extra- 
ordinary redundance  of  bile,  we  have  a  complete  clue  to 
the  epigastric  irritation  and  other  symptoms  of  disordered 
stomach  and  bowels,  which  characterized  the  bilious  ty- 
phus of  Bancker-street*.  In  the  fever  of  Bancker-street 
the  redundance  of  bile  was  not  so  great,  but  it  was  regur- 
gitated upon  the  stomach  more  than  on  the  intestines. 
The  tendency  to  diarrhoea  is  stronger  in  the  tropics,  owing 
to  the  relaxed  and  debilitated  condition  of  the  bowels  from 
the  influence  of  heat.  But  we  have  fresh  and  stronger 
evidence  at  our  own  doors. 

About  two  weeks  before  this  disease  began  to  prevail  in 
Bancker-street,  a  fever,  perfectly  similar  in  its  character 
-and  origin,  broke  out  and  continued  to  spread  for  some 

*  See  Curtis  on  the  Diseases  of  India.  &c.  Edinburgh,  1807.  p.  117—55. 


48 

months  in  the  apartments"of  the  Penitentiary,  a  building  si- 
tuated in  the  suburbs  of  this  city,  in  an  airy  open  field,  on 
the  banks  of  the  East  River.  The  persons  confined  in  this 
institution  were  crowded  together  to  a  degree  which  can 
scarcely  be  credited.  A  great  number  of  vagrants,  parti- 
cularly blacks,  who  had  been  principally  loungers,  about 
Bancker-street,  and  were  of  the  same  description  of  per- 
sons as  those  who  afterwards  were  seized  with  the  fever  in 
that  street,  had  been  recently  conveyed  to  this  prison, 
which  added  to  the  great  numbers  already  there,  rendered 
it  wholly  impracticable  to  accommodate  them. 

The  following  letter  of  the  Resident  Physician,  read  at 
the  meeting  of  the  Board  of  Health,  of  this  city,  July  5th, 
1 320,  gives  a  particular  account  of  the  condition  in  which  he 
found  the  Penitentiary,  a  few  days  before  the  disease  be- 
came epidemical  in  that  establishment : 

"  Dear  Sir — In  obedience  to  the  order  of  the  Board  of 
Health,  passed  at  their  meeting  on  the  3d  instant,  I  visited 
the  Penitentiary  on  the  afternoon  of  the  same  day,  accom- 
panied by  the  House  Physicians,  Dr.  Westervelt  and  Dr. 
Belden.  I  examined  most  of  the  apartments  of  the  insti- 
tution, more  especially  those  which  were  crowded,  and 
from  which  most  danger  from  disease  was  to  be  appre- 
hended. 

"  I  was  first  introduced  into  Hall  No.  2,  containing  50 
coloured  females.  The  air  of  the  apartment  was  exceedingly 
confined  and  offensive,  as  was  to  be  expected  from  so  great 
a  number  of  persons  immured  within  a  space  of  45  feet 
by  22. 

"  Hall  No.  4  is  of  the  same  dimensions,  and  contains  45 
white  females.  The  air  of  this  apartment  was  similar  to 
the  former,  scarcely  respirable.  But  the  back  Hail  No.  6 
was  in  a  still  more  offensive  state,  containing  both  black  and 
white  females  intermingled — 28  of  the  former,  and  21  of 
the  latter. 


t  49 

•"From  thence  we  proceeded  to  the  apartment  allotted 
to  the  boys.  This  too  was  crowded  with  30  boys,  some  co- 
loured, others  white,  and  all  within  a  room  not  exceeding 
8  or  10  feet  in  width,  and  about  40  in  length,  with  small  ad- 
jacent sleeping  rooms.  The  inhabitants  of  this  apartment, 
by  breathing  this  confined  and  impure  air,  have  lost  their 
healthy  hue,  the  greater  part  of  them  exhibiting  a  remark- 
ably pale  and  sickly  visage. 

"  In  this  part  of  the  establishment,  the  three  boys  whose 
sudden  death  was  reported  to  this  Board,  sickened  with  ty- 
phoid fever,  and  fell  victims  to  this  disease  after  two  or 
three  days  illness.  Their  sudden  death  is  probably  to  be 
ascribed  to  the  unhealthy  scorbutic  condition  of  their  sys- 
tems, antecedent  to  the  invasion  of  fever,  but  doubtless  in 
part  induced  by  the  confined  state  of  the  air  in  which  they 
lay  sick.  And  it  is  to  be  apprehended,  should  the  conta- 
gion be  renewed  in  any  other  members  of  the  same  crowd 
ed  apartments,  the  same  fatal  result  may  be  expected. 

"  The  condition  of  the  hospital  attached  to  the  institu- 
tion, instead  of  being  well  ventilated,  is  no  less  crowded 
and  injurious  to  the  sick. 

"  Upon  inquiry,  too,  it  was  found  that  a  very  unusual 
number,  especially  of  females,  have  been  recently  taken 
up  as  vagrants,  and  sent  to  the  penitentiary. 

"  To  this  cause  the  present  evils  are  to  be  attributed,  the 
apartments  not  being  of  sufficient  dimensions  for  their  ac- 
commodation. 

"  The  only  method  by  which  still  further  fatality  in  that 
institution  is  to  be  guarded  against  at  this  hot  season  of 
the  year,  is  either  to  discharge  from  the  house  some  of  the 
vagrants,  or  to  provide  additional  temporary  buildings  for 
their  reception  ;  for,  under  the  present  state  of  things,  a. 
commitment  to  the  penitentiary  involves  a  punishment 
much  more  severe  than  that  which  was  contemplated  by 
the  Legislature  in  the  organization  of  that  establishment. 
I  also  recommend,  and  have  expressed  the  same  to  the 

G 


50 

keeper,  that  the  walls  be  again  whitewashed  without  delay, 
and  that  this  process  be  repeated  at  least  monthly  during 
the  summer  season  ;  that  the  floors  be  frequently  cleansed, 
and  fresh  vinegar  daily  sprinkled  through  the  apartments, 
at  the  same  time  that  the  prisoners  be  supplied  with  a  large 
proportion  of  fresh  vegetables  and  fruits.  But  as  the  insti- 
tution is  under  the  care  of  eminent  physicians,  further  re- 
marks on  this  subject  become  unnecessary. 
"  I  am,  dear  sir,  very  respectfully,  yours, 

(Signed)  "  David  Hosack- 

"  TJie  Hon.  Peter  A.  Jay,  President,  pro  tempore, 
of  the  Board  of  Health*, ," 

These  predictions  were  lamentably  verified,  and  more 
than  one  hundred  cases  of  fever,  the  greater  number  of 
which  were  blacks,  broke  out  in  this  institution,  similar,  in 
every  respect,  to  the  fever  which  very  soon  afterwards 
made  its  appearance  in  the  cellars  and  filthy  apartments  of 
the  negroes,  in  Bancker-street  and  its  vicinty.  We  have 
the  authority  of  several  intelligent  and  highly  respectable 
physicians  for  saying  that  the  disease  in  the  penitentiary, 
at  Bellevue,  and  that  in  Bancker-street,  carried  the  most 
indubitable  evidence  of  identity,  both  in  the  assemblage  of 
their  symptoms,  and  in  the  causes  which  gave  rise  to  them. 
For  while  cases  were  occurring  at  the  penitentiary,  and 
placed  in  the  hospitals  there,  those  afflicted  with  the  fever 
in  Bancker-street,  were  conveyed  to  the  same  hospitals,  by 
which  means  the  diseases  were  brought  together  and  faith- 
fully compared. 

The  Attending  Physician  at  Bellevue,  also,  who  had  the 
care  of  the  patients  ill  of  this  fever,  confesses  it  to  have 
been  the  same  as  the  low  typhus  of  hospitals  and  ships  ;  and 
says  that  the  epigastric  irritation,  was  a  notable  symptom 
of  the  disease.     His  own  words  show  how  closely  the  peni- 

*  Statement  of  the  Commissioners  of  Health,  p.  17,18, 19. 


51 

ientiary  fever  resembled  that  of  Bancker-street.  "  During 
the  months  of  July,  August,  September,  and  the  early  part 
of  October,  there  occurred  at  that  establishment  a  disease 
exhibiting  many  characteristics  of  the  typhus  gravior,  jail, 
or  hospital  fever,  accompanied  with  bilious  symptoms,  es- 
pecially among  the  blacks,  such  as  yellowness  of  the  eyes 
and  skin,  epigastric  distress,  in  some  instances  so  great  as  to 
render  the  slightest  pressure  intolerable* '." 

It  has  appeared,  therefore,  somewhat  unaccountable  to 
us,  how  this  gentleman  should  have  signed  his  name  to  a 
statement,  declaring  yellow  fever  and  the  fever  of  Bancker- 
street  to  be  one  and  the  same  disease!- 

But  again,  as  if  proofs  were  constantly  multiplying  at  our 
hands,  and  opportunely  presenting  themselves  for  our  use, 
while  the  fever  was  prevailing  in  the  penitentiary  and 
Bancker-street,  a  disease  having  precisely  the  same  cha- 
racteristics broke  out,  at  the  very  same  time,  among  the 
blacks  in  the  filthy  alleys  and  courts  of  Philadelphia.  This 
too  was  confounded  by  the  physicians  with  yellow  fever, 
until  the  unfortunate  opportunity  occurred  of  contrasting 
them  together,  when  those  who  had  adhered  to  their  pre- 
judices with  the  greatest  obstinacy,  were  now  the  readiest 
to  admit  that  they  had  been  deceived.  The  preconceived 
notions  which  they  had  formed  of  the  disease,  took  their 
rise,  like  most  of  the  errors  which  cloud  this  subject,  from 
a  stubborn  persuasion  of  the  domestic  origin  of  yellow 
fever. 

The  only  account  we  have  of  this  fever,  which  has  been 
communicated  to  the  public,  is  contained  in  a  letter  from  Dr. 
Joseph  Klapp  to  J.  B.  Sutherland,  Esq.  It  triumphantly  es- 
tablishes the  identity  of  the  disease  with  that  of  Bancker- 
street  and  of  the  penitentiary,  and  shows  that  this  epigas- 
tric irritation,  as  well  as  all  the  other  symptoms  and  cir- 

*  Report  of  the  Medical  Society  Committee,  p.  11. 

*  See  Report  of  the  Medical  Society  Committee. 


52 

cumstances  of  the  Bancker-street  fever,  may  and  do  oc- 
cur in  genuine  typhus. 

The  disease  appears  to  have  prevailed  between  the  first 
of  July  and  last  of  September,  during  which  time  there  were 
brought  to  the  sugar-house  or  fever  hospital,  at  the  alms- 
house, about  two  hundred  patients.  They  chiefly  came 
"  from  Atkinson's  court,  Pine  alley,  Miles's  court,  and 
from  other  equally  filthy  and  dirty  places  both  in  the  city 
and  Liberties.  The  particular  forms  of  disease  which  they 
laboured  under,  appeared  to  be  the  low  remitting  fever  and 
the  different  grades  of  typhus.  These  complaints  are  such 
as  physicians  are  accustomed  to  meet  with  at  this  period  of  the 
year,  but  their  particular  prevalence  this  season  among  the 
blacks  must  be  attributed  to  a  general  want  of  employment, 
to  vicious  as  well  as  indolent  habits,  to  which  many  of  the 
lower  class  of  these  people  are  known  to  be  addicted  j  and 
further,  their  scanty  and  often  unwholesome  diet,  with  an  ha- 
bitual disregard  of  cleanliness,  both  personal  and  in  their 
dwellings,  have  doubtless  contributed  much  to  disseminate 
the  disease.  Many  of  them  pass  through  the  first  stages  of 
their  disease,  before  their  situation  becomes  known  to  the 
guardians  of  the  poor,  and  consequently  (as  Mr.  Jones  has 
already  asserted)  are  put  down  at  the  door  of  our  hospital, 
either  in  a  state  of  actual  dissolution,  or  they  have  been  so  far 
exhausted  as  to  preclude  all  hope  of  deriving  benefit  from  me' 
dical  application.  Under  such  circumstances,  the  mortali- 
ty of  the  disease  should  cease  to  be  a  matter  of  surprise. 
The  typhus  disease  was  the  one  most  prevalent.  It  was 
usually  introduced  by  a  chill,  and  considerable  subsequent 
excitement  of  the  circulation,  by  pain  in  the  head  and  ver- 
tigo, much  soreness  and  tension  of  the  epigastrium,  a  white 
tongue,  and  a  prostration  of  the  muscular  system.  Much 
general  debility  usually  appeared  between  the  third  and 
fifth  days,  and  the  disease  in  many  instances  came  to  a  termi- 
nation between  the  seventh  and  tenth  days*." 

*  American  Medical  Recorder,  vol.  IV.  No.  xiij.  p.  83. 


53 

Again ;  "  The  principal  determinations  were  to  the  head 
and  stomach.  In  the  latter  respect,  there  was  a  difference 
from  ordinary  typhus,  and  from  its  being  a  symptom  com- 
mon to  both  it  and  yellow  fever,  some  were  at  first  dispos- 
ed to  believe  them  the  same.  This  opinion,  however,  at- 
tained to  a  very  limited  extent,  and  I  believe  in  the  latter 
part  of  the  season,  when  all  had  an  opportunity  of  contrast- 
ing them,  the  opinion  of  their  identity  was  relinquished  b}r 
every  one.  A  circumstance  evincing  the  diversity  of  their 
character,  is  Ihe  fact  of  their  prevailing  in  different  districts  of 
our  city.  I  do  not  recollect  to  have  heard  of  a  single  well-mark- 
ed case  of  yellow  fever  originating  in  the  dirty  alleys,  remote 
from  the  river  Delaware,  though  abounding  throughout  the 
summer  with  cases  of  typhus,  intermittens,  and  remittents. 
My  public  and  private  practice  afforded  me  many  opportu- 
nities of  instituting  a  comparison  between  the  symptoms  of 
the  two  epidemics,  which  enabled  me  to  detect  the  follow- 
ing differences  between  them :  First,  in  the  typhus  of  the 
blacks,  in  the  very  first  stage,  the  epigastric  region  evidences 
great  sensibility  to  the  touch,  whereas  in  the  malignant  yellow 
fever  this  sensibility  does  not  usually  occur  until  about  the 
third  day.  The  particular  seat  of  this  morbid  sensibility  is 
different  in  the  two  diseases  ;  in  the  former  it  is  more  exter- 
nal, while  in  the  latter  it  is  more  internal.  Secondly,  in  the 
typhus  the  most  active  as  well  as  the  most  unpleasant  re- 
medies are  generally  retained  with  ease  on  the  stomach ; 
not  so  in  the  yellow  fever.  Thirdly,  in  the  different  stages 
of  typhus,  the  tongue  undergoes  the  several  changes  cha- 
racteristic of  that  disease,  but  in  the  yellow  fever  it  pre- 
sents a  different  appearance  ;  in  no  case  of  that  disease, 
have  I  met  with  the  hard  and  glossy  tongue,  the  usual  attend- 
ant on  the  former.  Fourthly,  haemorrhages  in  the  second 
and  last  stages  of  typhus  are  uncommon,  but  very  common 
in  yellow  fever.  Fifthly,  in  the  typhus  there  b-  an  early 
prostration  of  the  muscular  powers ;  not  so  in  yellow  fe- 
ver.    Sixthly,  the  yellow  or  icteric  eye  marks  the  first  stage 


54 

of  the  typhus,  but  in  yellow  fever  it  rarely  occurs  before  the 
third  day-  Seventhly,  black  vomit  very  common  in  the  se- 
cond and  last  stages  of  yellow  fever,  and  very  uncommon  in 
the  typhus  of  the  coloured  people.  Eighthly,  the  convales- 
cent state  of  yellow  fever  is  generally  short,  and  as  gene- 
rally tedious  in  the  typhus*." 

Out  of  the  large  number  who  died  of  this  disease,  there 
were  five  cases  in  which  a  dark  coloured  matter  was  void- 
ed from  the  stomach,  "  something  like  black  vomit."  The 
substance  "  appeared  to  be  composed  of  a  mucous  secre- 
tion of  blood,  and  the  common  contents  of  the  stomach  in- 
timately blended."  Dr.  Klapp  judiciously  observes,  that 
these  suspicious  cases  ought  to  be  considered  as  anoma- 
lous, and  by  no  means  as  conclusive  evidence  of  this  dis- 
ease having  been  yellow  fever.  For  we  are  told  by  this 
writer  that  black  vomit  may  occur  in  intermittents,  remit- 
tents, cramp  of  the  stomach,  pleurisy  of  the  winter  season, 
gastritis  from  drinking  cold  water  when  the  body  has  been 
much  heated,  in  dropsy,  consumption,  &ct. 

Fevers  similar  to  that  of  Bancker-street,  not  only  in  be- 
ing accompanied  with  bilious  symptoms  like  that  of  1801? 
but  also  with  a  peculiar  irritation  of  the  precordia,  have  re- 
peatedly occurred  in  this  city  in  previous  years.  And  if 
sufficient  evidence  had  been  adduced  of  the  occurrence  of 
vomiting  of  dark  matter  in  the  Bancker-street  fever,  we 
have,  in  addition  to  the  remark  of  Dr.  |Klapp,  proof  di- 
rectly in  point,  that  this  symptom  too  may  now  and  then 
exist  in  true  typhus,  but  that  it  is  essentially  different  from 
the  black  vomiting  of  the  yellow  fever.  "  I  began,"  says 
Dr.  Samuel  Bard|,  "  to  practise  medicine  in  New- York 
in  1766.  Remitting  fevers  have,  since  that  time,  prevailed 
more  or  less  every  fall.     They  frequently  were  attended 

*  American  Medical  Recorder,  vol.  IV.  No.  13.  p.  85. 
t  lb.  p.  86—7. 

%  Now  President  of  the  College  of  Physicians  and  Surgeons  of  the  Univer- 
sity of  New- York. 


55 

with  bilious  discharges,  and  a  yellow  skin ;  and  in  propor- 
tion as  these  symptoms  prevailed,  were  termed  bilious  re- 
mittents ;  in  some  instances  these  symptoms  have  run  very 
high,  and  the  accompanying  fever,  in  such  cases,  has  gene- 
rally been  more  ardent  and  constant ;  but  nevertheless  sensible 
remissions  so  generally  accompanied  them,  that  they  were  ge- 
nerally looked  for;  and  it  is  now  thought  the  duty  of  the 
physician  to  watch  for  them,  and  by  emetics,  other  evacua- 
tions, and  blisters,  to  promote  them,  so  as  to  procure  an 
opportunity  to  administer  the  Peruvian  bark,  by  which  the 
cure  was  generally  completed.  Now  and  then,  and  parti- 
cularly during  the  war,  when  the  city  was  much  crowded, 
and  little  attention  paid  to  cleanliness  ;  fevers  of  a  more  ma- 
lignant nature  have  prevailed,  in  which  a  foul  mouth,  he- 
morrhages, petechial  eruptions,  and  other  marks  of  dissolu- 
tion, have  either  characterized  the  disease  from  its  com- 
mencement,  or  been  superadded  to  the  bilious  symptoms  in 
the  latter  stages ;  and  then  the  disease  has  been  termed 
malignant,  putrid  petechial,  jail,  or  hospital  fever.  In  such 
cases  I  have  now  and  then  seen  profuse  bloody  discharges, 
and  black,  or,  as  it  is  now  more  generally  named,  coffee- 
ground  vomiting*  ;  but  a  more  frequent  symptom  in  these 
fevers,  and  one  I  do  not  remember  to  have  seen  in  yellow 
fever,  is  the  apthous  crust  with  which  the  mouth  and  throat 
is  often  lined.  In  these  fevers  death  seldom  occurs,  nor  is 
a  crisis  often  to  be  expected  before  the  seventh  day,  and 
both  are  frequently  protracted  to  the  fourteenth,  or  even  to 
the  twentieth.  Such  were  the  cases  of  my  sister  during  the 
war,  and  of  my  son  about  six  months  ago,  which  you  have 
frequently  heard  me  mention.  Just  before,  and  what  gave 
occasion  to  the  appointment  of  health  officer  of  New- York, 
about  the  year  1758  or  '59,  a  ship  crowded  with  Germans 


*  "  Is  this  of  the  same  nature,"  says  Dr.  Bard,  in  a  note,  «  with  the  black 
vomiting  of  the  yellow  fever  ?    I  suspect  not." 


56 

arrived  there  in  a  very  sickly  state,  and  were  put  under 
my  father's  care.  He  procured  accommodations  for  the 
sick  at  a  little  distance  from  town  ;  and  I  have  heard  him 
say,  that  out  of  five  or  six  pupils  and  attendants,  he  was  the 
only  person  who  escaped  the  disease.  This  disease  he  al- 
ways called  ship  or  jail  fever,  but  never  yellow  fever;  and 
it  is  worthy  of  observation,  that  he  had  seen  the  yellow  fe- 
ver which  prevailed  in  New-York  about  the  year  1744. 
Another  instance  of  the  same  kind  occurred  whilst  I  was 
health  officer — I  mean  the  ship  in  which  Mr.  M'Clain  came 
from  Scotland  ;  in  which,  out  of,  I  think,  about  three  hun- 
dred passengers,  upwards  of  seventy  died  ;  but  of  those,  I 
saw  no  one  which  in  the  least  resembled  yellow  fever. 
The  first  case  of  fever  I  ever  saw  with  that  assemblage  of 
symptoms  we  have  since  denominated  yellow  fever,  was 
the  case  of  Mr.  Jenkins  (1795),  &c*." 

The  spotted  fever,  which  has  occasioned  so  much  inter- 
est among  the  physicians  of  this  country,  and  particularly 
of  the  New-England  States,  appears  to  have  been  a  disease 
of  the  typhoid  type.  It  prevailed  in  the  winter,  about  the 
month  of  January.  There  was  here  also  an  indescribable 
anguish  about  the  precordia.  Vomiting  also  frequently  oc- 
curred, which  from  being  at  first  merely  the  ingesta  or  a 
greenish  liquor,  obeyed,  as  the  spring  advanced  the  influ- 
ence of  the  season,  and  became  bilious,  like  that  of  the 
Bancker-street  fever. 

There  was  neither  yellowness  of  the  skin  or  adnata ;  but 
its  course,  like  that  of  the  bilious  typhus  of  Bancker-street, 
was  also  hurried,  terminating  when  fatal  usually  before  the 
fifth  day. 

The  tongue  was  generally  moist,  but  if  the  disease  con- 
tinued beyond  the  third  or  fifth  day,  it  became  darker  co- 

*  Additional  Facts  and  Observations  relative  to  the  nature  and  origin  of 
the  Pestilential  Fever,  by  the  College  of  Physicians  and  Surgeons  of  Phila- 
delphia. Philadelphia  r  1806.  Letter  of  Dr.  S.  Bard  to  Dr.  D.  Hosack, 
pp.  15,  16,  17. 


57 

loured,  and  yellow  or  brown.  Other  circumstances  also 
bespeak  its  typhoid  character,  such  as  great  prostration  of 
strength,  low  frequent  pulse,  depraved  sensations,  deliri- 
um, coma,  and  finally  petechia?  all  over  the  surface,  toge- 
ther with  the  tonic  and  cordial  treatment  most  generally 
had  recourse  to,  and  which  was  most  successful.  We  are 
furthermore  confirmed  in  this  opinion  by  the  committee  of 
the  Massachusetts  Medical  Society,  who  have  furnished 
the  most  accurate  and  authentic  accounts  of  this  dis- 
ease : 

"  It  appears  also,"  say  they,  "  that  in  various  parts  of 
the  Commonwealth,  the  common  typhus  is  much  more  fre- 
quent than  usual  at  this  season  of  the  year ;  appearing  in 
many  instances  with  its  ordinary  symptoms,  but  in  others 
with  a  character  more  or  less  resembling  the  disease  which 
we  have  described." 

As  in  the  fever  in  Bancker-street,  in  that  described  by 
Dr.  Bard,  and  in  that  of  the  Philadelphia  alms-house,  there 
were  not  wanting  cases  with  dark  and  suspicious  vomit- 
ings ;  which  gave  occasion  to  considerable  alarm,  and  led 
several  to  suppose  that  the  matter  ejected,  was  no  more 
nor  less  than  the  real  black  vomit.  The  language  of  the 
committee  will  place  this  subject  in  its  proper  light,  and 
taken  in  conjunction  with  the  time  of  year  in  which  the 
spotted  fever  was  most  prevalent,  [January,]  and  the  ap- 
pearances on  dissection,  show  us  how  much  credit  was 
to  be  attached  to  these  conjectures.  "  In  several  fatal 
cases  at  Lancaster,  and  two  not  fatal,  a  dark  matter  was 
thrown  up,  which  was  called  black  vomit.  Whether  this 
matter  was  the  same  called  by  that  name  in  the  autumnal 
fevers  of  warmer  climates,  the  committee  are  not  assured." 
Again  ;  "  The  coats  of  the  stomach  were  generally  free 
from  the  slightest  morbid  appearance:  its  contents  had 
sometimes  a  resemblance  to  coffee  grounds,  or  more 
nearly  to  brown  soup,  while  in  other  cases   they  con- 

H 


58 

sisted  of  greenish  mucus  :  each  without  any  offensive 
odour*.'5 

These  important  facts  teach  us,  that  we  are  not  always 
to  attach  such  frightful  apprehensions  to  symptoms  of  pre- 
cordial irritation,  and  that  Ave  are  by  no  means  to  suppose 
that  this  or  the  vomiting  of  a  dark  greenish  bile  are  always 
to  be  looked  upon  as  the  certain  forerunners  of  gangrene 
and  sphacelus  of  the  stomach.  Much  less  is  the  detection  of 
a  discoloured  water  in  the  stomach,  after  death,  to  be  taken 
as  the  consequence  of  such  derangement,  or  an  indication  of 
the  existence  of  the  matter  of  black  vomit  during  life\. 
This  mode  of  reasoning  a  posteriori  rarely  leads  to  satis- 
factory results ;  but  it  is  one  which,  however  unphiloso- 
phical  it  may  be  thought  to  be,  is,  we  regret  to  see,  too 
often  employed  J. 

The  irritation  at  the  prcecordia,  is  one  of  the  symptoms 
also  of  the  autumnal  inflammatory  remittent  of  the  Southern 
States,  a  disease  peculiarly  obnoxious  to  strangers,  and  ve- 
ry different  from  the  endemial  bilious  remittent  of  that  part 
of  our  country,  or  from  typhus  fever§. 

In  the  endemic  fever  of  Bengal,  commonly  called  marsh 

*  See  Transactions  of  the  Massachusetts  Medical  Society,  vol.  II.  Also, 
American  Medical  and  Philosophical  Register,  vol.  I.  p.  12,  373,  176.  Vol. 
III.  p.  482. 

f  Burnett,  a  voluminous  author  on  the  Mediterranean  Fever,  avers  that 
this  disease  continues  through  the  winter,  and  is  then  "often  accompanied 
by  severe  and  evident  inflammation  of  the  lungs."  What  must  be  thought  of 
this  assertion-  when  it  is-known  that  the  Mediterranean  fever  was  the  iden- 
tical yellow  fever  of  the  tropics  !  Burnett  was  desirous  of  proving  the  iion- 
contagionsness  of  this  disease,  and  that  it 'was  entirely  attributable  to  at- 
mospheric influence.  To  do  this,  it  was  necessary,  as  much  as  possible,  to 
liken  it  to  the  ordinary  fevers  of  the  Mediterranean.  Hence,  perhaps,  the 
explanation  how  this  remark  escaped  him,  and  another  still  more  singular 
and  incredible,  that  black  vomit  was  in  some  cases  found  to  be  a  very  rare 
occurrence. — Burnett  on  the  Mediterranean  Fever,  Land.  1816,  p.  11,  423, 
491,  kc. 

\  See  Report  of  the  Medical  Society  Committee  of  this  city,  p.  26 — 7. 
§  Vide  JNToicom's  Observations  on  the  Fevers  of  North  Carolina.     Ame- 
rican Medical  and  Philosophical  Register,  vol.  I.  p.  17. 


59 

remittent  fever,  occasioned  by  the  inundation  of  the  Gan- 
ges, one  of  the  most  distinguishing  symptoms  is  oppres- 
sion on  the  prcecordia,  and  excruciating  pain  at  the  stomach. 
The  vomitings  were  always  bilious,  and  emetics  were  dan- 
gerous. The  disease  being  of  an  inflammatory  type,  ve- 
nassection  was  found  eminently  useful.  The  disease,  like 
the  inflammatory  remittent  spoken  of  by  Norcom,  prevails 
in  August  and  September,  and  attacks  more  particularly 
strangers*.  Indeed,  the  gastric  or  precordial  irritability, 
according  to  Johnson,  together  with  pain  of  the  head,  con- 
stitute the  pathognomonic  symptoms  of  the  bilious  fever, 
or  grand  endemic  of  hot  climates.  This  is  a  fever  which 
occurs  on  land  or  at  sea,  independent  of  marsh  miasmata, 
which  seem  however  to  have  a  modifying  influence  upon 
it,  as  in  the  endemic  of  Bengali. 

4.  Duration.  In  some  few  instances,  the  fever  of  Banck- 
er-street  terminated  fatally  within  the  space  of  a  week. 
Great  pains  were  taken  to  make  a  handle  of  this  circum- 
stance ;  and  it  was  held  forth  as  a  strong  evidence  of  the 
analogy  between  yellow  fever  and  this  disease.  The  do- 
cuments in  possession  of  the  Board  of  Health,  however,  and 
under  the  signature  of  the  physicians  who  reported  these 
cases,  show  that  not  one  of  them  was  seen  by  these  gentle- 
men more  than  once,  and  then  in  several  instances  not  un- 
til after  death !  The  account  of  their  symptoms,  there- 
fore, was  derived  from  the  persons  in  whose  apartments 
they  died,  and  cannot  be  fully  depended  upon.  As  far  as 
has  been  ascertained,  however,  it  appears  that  their 
symptoms  were  very  nearly  those  of  the  more  sudden 
forms  of  congestive  typhus  described  by  Armstrong,  as  oc- 
curring in  England  ;  where  yellow  fever  has  never  been 
supposed  to  exist,  strange  as  it  may  seem,  even  by  the 

*  Johnson  on  the  influence  of  tropical  climates  on  European  constitutions 
London,  1818,  p.  40 — 87.  Also  Clarke  and  Lind,  who  have  also  treated  of 
this  fever. 

f  lb.  p.  105. 


60 

most  inflexible  advocate  of  the  domestic  origin  of  the  dis- 
ease. 

The  congestive  typhus  of  Armstrong  sometimes  termi- 
nated in  death  in  40  or  72  hours*.  Among  other  symp- 
toms which  showed  themselves  in  the  cases  described  by 
Armstrong  in  the  beginning  of  the  disease,  were  "  invo- 
luntary sighing,  and  a  sensation  of  weight  and  distress  at  the 
pit  of  the  stomach.  The  countenance  soon  acquired  a  look 
of  extreme  agitation,  and  the  skin  was  dry  on  the  trunk, 
and  damp  on  the  extremities ;  the  centre  of  the  tongue 
white,  but  moist ;  and  evidences  of  internal  excitement 
gradually  dexeloped  themselves ;  the  pulse  being  small 
and  hurried,  the  beat  sharp  and  concentrated  about  the 
prsecordia,  but  lower  than  natural  on  the  wrists,  ankles, 
forehead,  and  lobes  of  the  earst."  On  dissection,  "  the 
brain,  liver,  and  spleen  were  the  only  parts  chiefly  engorg- 
ed with  blood,  the  two  latter  organs  [as  is  mentioned  of  the 
spleen  by  the  Medical  Society  Committee,  p.  27]  being 
ruptured  by  the  forcible  pressure  of  the  handj,"  Most  of 
the  cases  that  proved  fatal  in  this  manner  in  Bancker- 
street,  occurred  in  subjects  whose  systems  were  complete- 
ly paralyzed  and  destroyed,  by  the  use  of  ardent  spirits  and 
a  most  violent  course  of  debauchery.  In  the  majority  of 
cases,  the  fever  of  Bancker-street  extended  beyond  a  week  ; 
and  generally,  when  it  terminated  fatally,  ended  in  less 
than  a  fortnight.  In  instances  more  mild,  its  duration  was 
protracted  to  longer  periods,  observing  the  same  diversity 
in  this  respect  with  ordinary  typhus.  So  in  the  inflamma- 
tory typhus  of  Armstrong,  where  the  brain  was  deeply  in- 
volved, the  disease  was  not  protracted  much  beyond  the 
first  week§.  In  that  where  the  chest  was  implicated,  it  of- 
ten terminated  "  within  the  first  nine  days||,''  and  where 
the  bowels  were  the  seat  of  the  local  inflammation,  the 


*  Armstrong  on  Typhus,  &c.  Cases,  p.  71,  2,  3. 

+  lb.  p.  73.  %  lb.  p.  73,  4.  §  lb.  p.  30.  ||  lb.  p.  41. 


61 

disease  was  known  to  terminate  "  at  the  expiration  of  the 
first  week*."  The  bilious  form  of  typhus  which  prevailed 
simultaneously  in  Philadelphia  with  the  Bancker-street 
and  penitentiary  fevers,  we  have  also  seen  terminated,  in 
many  instances,  between  the  seventh  and  tenth  days. 

The  author  of  a  very  able  Review  on  the  Report  of  the 
Medical  Society  Committee,  which  appeared  in  the  Ameri- 
can Medical  Recorder  for  April,  1 821,  has  also  collected  a 
great  number  of  high  authorities  to  prove  that  typhus  may 
run  a  very  rapid  course.  We  will  avail  ourselves  of  his 
remarks  and  references  on  this  point,  without  deeming  it 
necessary  to  make  an  apology  for  so  doing. 

Sir  John  Pringle,  in  speaking  of  hospital  fever,  says  that 
"  when  the  air  is  at  the  highest  pitch  of  malignity,  the  course 
of  the  disease  comes  to  be  very  rapid*  so  as  to  terminate  in 
jive  or  six  days,  in  death,  or  a  favourable  crisis!."  Wilson 
says,  "  typhus  sometimes  terminates  in  10  or  13  davs,  or 
within  that  periodic  Both  Drs.  Bateman  and  Rogan,  in 
the  works  already  quoted,  relate  cases  of  typhus  terminating 
on  the  6th  and  3th  day  of  the  disease§.  Even  Dr.  Thomas, 
an  author  from  whom  we  suspect  most  of  the  medical 
knowledge  contained  in  the  Report  has  been  derived, 
speaks  in  the  following  terms :  "  In  warm  climates  it  (ty- 
phus) seldom  continues  above  a  week  or  ten  days,  if  so 
long\\. 

Some  of  the  cases  of  this  disease  were  nearly  as  rapid  in 
their  course  as  the  putrid  bilious  fever  described  by  Mose- 
leylT.  This  has  probably  induced  the  author  of  the  re- 
marks on  theMedical  Society  Committee's  Report,  toob- 

*  Armstrong  on  Typhus,  &c.  Cases,  p.  61. 

t  Observations  on  the  Diseases  of  the  Army,  &c.  p.  304. 

X  A  Treatise  on  Febrile  Diseases,  by  A.  P.  Wilson,  vol.  i.  p.  137. 
Am.  Ed. 

$  Bateman  on  the  Contagious  Fever,  &c.  p.  50.  Rogan  on  Epidemic  of  Ire- 
land, p.  25. 

||  Practice  of  Physic,  p.  52.  4th  American  edition, 

TT  See  p.  18  of  this  Essay. 


62 

serve,  that  the  two  diseases  were  nearly  alike.  There 
does  not  appear,  however,  to  have  been  so  great  a  disposi- 
tion to  putrescency  in  the  fever  described  by  Moseley  as 
in  that  of  Bancker-street,  though  there  was  a  much  great- 
er redundancy  of  bile.  Whereas  in  the  Bancker-street  fe- 
ver, the  putrid  generally  predominated  over  the  bilious 
symptoms,  particularly  in  fatal  cases.  The  putrid  bilious 
fever,  when  fatal  also;  terminated  as  soon  as  the  third  or 
fourth  day.  But  it  will  be  said,  perhaps,  that  all  these  dif- 
ferences may  be  easily  explained  away.  In  truth,  it  would 
prove  no  easy  task  to  say  where  the  line  of  demarcation 
between  the  two  diseases  actually  exists.  Nor  would  it 
be  difficult  to  conceive,  from  the  strong  analogy  between 
many  of  their  more  important  phenomena,  that  they  both 
belong  to  the  same  species.  The  disease  is  called  by 
Moseley,  putrid  bilious  fever,  or  a  high  grade  of  bilious  re- 
mittent. This  is  somewhat  contradictory :  for  if  it  was 
a  putrid  bilious  fever,  we  ought  to  understand  by  the 
phraseology  that  it  was  a  bilious  typhus  ;  and  if  it  was  a 
bilious  remittent  of  a  high  grade,  we  are  naturally  to  take 
it  for  granted,  that  it  commenced  as  an  ordinary  bilious  re- 
mittent, and  terminated  in  putrid  or  typhoid  symptoms. 
Those  who  believe  it  to  have  been  the  same  disease  as  the 
fever  of  Bancker-street,  and  that  both  were  of  the  typhoid 
type  from  the  commencement,  will  say  that  the  putrid  bi- 
lious fever  of  Moseley  was  not  so  strongly  marked  by  pu- 
trid symptoms,  because  the  climate  of  the  tropics  being 
unfavourable  to  animal  ization*,  as  well  as  to  the  concen- 
tration of  febrile  infection,  exercises  an  antiseptic  influ- 
ence over  the  system.  In  support  of  this  argument  they 
will  adduce  the  fact  that  typhus  more  frequently  occurs, 
and  that  the  septic  tendency  is  much  greater  in  cold  than 
in  hot  latitudes,  in  winter  than  in  summer.  They  will 
moreover  allege  that  the  putrid  bilious  fever  of  Moseley, 
originated  as  the  worst  forms  of  typhus  usually  do,  in  asitua- 

*  Moseley  on  Tropical  Diseases,  p.  92. 


63 

tion  where  great  numbers  were  crowded  together,  and  where 
the  disease  might  have  been  reasonably  anticipated.  And 
that  the  great  redundance  of  bile  was  the  natural  conse- 
quence of  the  season  of  the  year  at  which  the  disease  pre- 
vailed, and  its  occurring  in  the  tropics,  where,  according  to 
Blane,  typhus  is  usually  accompanied  by  bilious  symptoms. 
That  as  to  the  duration  of  putrid  bilious  fever,  all  fevers 
run  their  course  sooner  in  hot  than  in  cold  climates!.  In 
opposition  to  this  we  would  urge  that  the  bilious  symp- 
toms had  undoubtedly  more  to  do  with  its  fatality  than  its 
typhoid  character,  which  is  proved  by  the  complete  success 
which  attended  the  introduction  of  manna  and  cream  of  tar- 
tar, after  the  disease  had  carried  off  a  great  number  of  the 
troops.  For  by  giving  this  combination  until  the  bile  was 
entirely  evacuated  by  the  stools,  the  disease  was  effectually 
subduedj.  This  important  fact  in  regard  to  the  treatment 
of  the  disease,  together  with  the  circumstance  that  the 
troops  were  exposed  to  the  influence  of  marsh  miasmata, 
and,  therefore,  to  remittent  fever ;  as  also  the  fact  that  the 
remittent  fever  of  the  tropics,  is  peculiarly  charaterized  by 
bilious  symptoms,  ought,  we  think,  without  taking  into  view 
the  rapid  termination  of  the  disease,  or  the  absence  of  well- 
marked  typhoid  symptoms,  to  incline  us  rather  to  the  opi- 
nion that  the  two  diseases  were  specifically  different. 

5th*  The  season  of  the  year  at  which  the  disease  ap- 
peared. It  has  been  contended  by  some  persons,  with 
zeal  not  very  creditable  to  their  medical  erudition,  that 
this  disease  could  not  have  been  typhus  because  cases 
of  it  happened  to  occur  in  the  latter  part  of  August,  when 
the  summer  heat  was  not  yet  expended.  We  acknowledge 
that  the  fever  of  Bancker-street  was  rife  in  the  month  of 
September  ;  a  month  which  is  nominally  autumnal,  but  cer- 
tainly, in  this  climate,  a  genuine  summer  month  in  its  tem- 
perature.    Is  it  then  an  unalterable  law  of  typhus,  that  it 

+  Blane  on  Diseases  of  Seamen,  p.  395,  &c. 
%  Moseley  on  Tropical  Disease,  p.  181,  &c. 


64 

cannot  become  matured  and  ripened  except  under  the 
frosts  of  winter?  We  know  that  the  disease  deriving  its 
origin  most  usually  from  human  effluvia,  does  not  need 
the  aid  of  marsh  miasms  to  bring  it  into  existence.  The 
effluvia  arising  from  persons  being  crowded  together  into 
close  confined  apartments,  will  alone  engender  the  disease 
without  any  other  cause  whatever  ;  and  although  the  sur- 
face of  the  earth  be  at  the  same  time  frozen  and  covered 
with  snow.  But  have  we  not  the  very  highest  authority — 
have  we  not  our  own  daily  experience  to  show  us,  that  ty- 
phus will  appear  under  the  very  highest  temperature  of 
summer  ?  Is  it  not  possible  to  conceive  that  the  same  efflu- 
via to  which  it  is  so  generally  indebted  for  its  production, 
may,  from  a  peculiar  concurrence  of  circumstances,  be 
accumulated  in  such  force  and  quantity,  that  even  the  high 
temperature  of  August,  could  not  fast  enough  volatilize  it, 
io  prevent  it  from  innoculating  the  human  system  with  its 
poison  ?  Sir  Gilbert  Blane,  who  first  suggested  the  ingeni- 
ous opinion  that  the  matter  of  infection  or  contagion,  is 
readily  dissipated  under  a  powerful  sun,  gives,  neverthe- 
less, innumerable  examples  of  the  susceptibility  of  the  hu- 
man constitution  to  typhus,  even  under  the  heat  of  a  tropi- 
cal summer.  In  the  immense  fleet  of  the  line  of  which  he 
had  the  superintendance,  and  to  which  we  have  already  al- 
luded, instances  constantly  occurred  of  typhus  in  certain 
ships  in  which  the  presence  of  peculiar  causes  particularly 
favoured  its  production  and  development*. 

"In  England  (says  Armstrong)  typhus  is  evidently  favour- 
ed Hy  a  low  temperature,  being  most  prevalent  in  the  cold 
seasons  of  winter  and  spring,  generally  abating  or  disap- 
pearing, as  the  heat  of  summer  advances,  and  often  pre- 
vailing to  a  considerable  degree  in  cold  wet  autumns  ;  but, 
nevertheless,  it  occasionally  prevails  at  all  times  in  the 
year,  and  is  even  undiminished  by  the  hottest  weather  in  this 

*  Vide  Blane  on  Diseases  of  Seamen,  passim. 


65 

country,  as  1  once  witnessed  when  the  thermometer  was  un- 
usually high  during  the  greater  part  of  a  summer*. 

We  again  call  to  our  assistance  the  researches  made  into 
this  part  of  our  subject,  by  the  author  of  the  masterly  re- 
view of  the  singular  production  which  issued  from  the  Medi- 
cal Society. 

.Sir  John  Pringle,  in  his  observations  on  the  hospital  or 
jail  fever,  which  is  the  same  as  the  typhus  gravior,  tells  us 
that  "  the  hospitals  of  an  army,  when  crowded  with  sick,  or 
when  the  distempers  are  of  a  putrid  nature,  or  at  any  time 
when  the  air  is  confined,  especially  in  hot  and  dry  weather, 
produce  a  fever  of  a  very  malignant  kind,  and  very  mor- 
tal!."  In  confirmation  of  this,  he  states,  that  in  1 743  the 
hospital  or  jail  fever  prevailed  in  the  army  in  the  month  of 
July  and  Augustf .  In  1 746  it  broke  out  in  May  and  June§, 
and  in  1 748  it  raged  in  July,  when  the  weather  is  described 
as  having  been  extremely  hot  and  dry||. 

Dr.  Willan  describes  typhus  fever  as  occurring  in  London 
in  August  and  September,  and  adds,  "  this  disease  is  ex- 
tended by  infection,  during  the  months  of  October  and  No- 
vember, but  its  progress  is  generally  stopped  by  the  frosts 
of  December^." 

Dr.  Bateman  says,  "  at  all  times  there  appears  to  be  a 
greater  disposition  to  fever  in  London  during  the  autumnal 
months,  which  diminishes  with  the  approach  of  winter. 
The  present  epidemic,  (typhus,)  if  we  may  deduce  such  an 
inference  from  the  demands  upon  the  house  of  recovery, 
was  most  particularly  prevalent  from  the  beginning  of  Au- 
gust to  the  middle  of  November.  The  monthly  admissions 
were — in  June  28,  July  22,  August  67,  September  81,  Oc- 
tober 109,  November  92,  December  68**." 

*  Armstrong  on  Typhus,  p.  9. 
"(^Observations  on  Diseases  of  the  Army,  &c.  p.  291. 
$  lb.  p.  27.        i  lb.  p.  57.        ||  lb.  p.  75. 
IT  Willan  on  the  Diseases  of  London,  p.  43. 

**  Bateman  on  the  Epidemic,  &c.  prevailing  in  London,  1818,  p.  16. 

I 


66 

In  1817  and  18,  typhus  raged  epidemically  in  Belfast, 
Ireland.  It  commenced  in  May,  and  prevailed  extensively 
throughout  all  the  summer  and  autumnal  months*.  We 
shall  now  quote  two  or  three  American  authorities,  to  prove 
the  same  point.  A  very  sensible  physician  and  writer,  Dr. 
Gallup,  of  Vermont,  says,  "  this  disease  (typhus)  prevails 
most  frequently  in  August  and  September  ;  but  no  month  is 
free  from  it,  especially  the  fore  part  of  the  cold  seasonf ." 

The  seventh  volume  of  the  New-England  Journal  of 
Medicine  and  Surgery,  contains  an  account  of  a  typhus  fe- 
ver, which  prevailed  in  the  Boston  alms-house  in  181 7,  18, 
and  which  broke  out  in  the  month  of  MayJ.  "  In  the  hot 
months  of  the  year,  (says  Johnson,)  the  fever  [at  Seringa- 
patam]  becomes  remittent  or  typhoid^." 

7.  In  many  cases  of  the  Bancker-street  fever,  instead  of 
the  biting  heat  or  calor  mordax  of  typhus,  there  was  ob- 
served a  peculiar  coldness  and  dampness  of  the  skin,  indi- 
cating a  much  lower  temperature  than  natural.  This  has 
been  compared  to  the  moist  clammy  state  of  the  surface,  so 
often  seen  in  the  second  stage  of  yellow  fever.  Overlooking 
the  ensemble  of  phenomena,  premature  inductions  have 
been  made  from  this  symptom,  in  favour  of  the  identity  of 
the  two  diseases.  In  the  Bancker-street  fever  this  symptom, 
as  well  as  the  low  sunken  pulse,  were  seen  in  those  cases 
where  there  existed  an  extreme  degree  of  prostration,  the 
natural  effect  of  the  poison  of  the  disease  operating  upon  a 
habit  of  body  already  exhausted  and  broken  down  by  de- 
bauchery. The  same  symptom  was  noticed  in  a  fever  which 
appeared  among  the  British  troops  at  Mariegalante,  West 

*  See  Observations,  &c.  on  the  Epidemic  in  Ireland,  by  Francis  Rogan, 
M.  D.  &c.  p.  150—1. 

t  Sketches  of  Epidemic  Diseases  in  the  state  of  Vermont,  &c.  by  Joseph  A. 
Gallup,  M.  D.  p.  363. 

X  See  Vol.  VII.  p.  105. 

§  Johnson  on  the  influence  of  Tropical  Climates  upon  European  constitu- 
tions, p.  99. 


67 

Indies,  in  December,  1808,  the  phenomena  and  circum- 
stances of  which  disease,  bore,  indeed,  in  most  of  the  cases. 
an  extraordinary  resemblance  to  the  fever  of  Bancker-street. 
It  commenced  at  night  with  chill ;  heat,  followed  by  low  tem- 
perature of  the  skin,  lower  than  usual  in  the  commence- 
ment of  yellow  fever — thirst — flushed  face — eyes  tinged — 
pulse  now  full,  firm,  and  frequent — skin  moist  and  soft — re- 
mission in  the  morning — pulse  less  full,  and  often  irregular 
— tongue  before  white,  now  thickly  coated  with  mucus, 
whitish  round  the  edges,  but  very  foul  and  brown  in  the 
middle — debility — dull,  heavy  sensation  in  the  head — pro- 
pensity to  sleep — at  noon,  febrile  symptoms  recur,  but  in- 
creased in   violence  and   duration — remmission  then  less 
complete,  and   exacerbation  earlier.     In  general  J.here  is 
no  third  remission — the  fever  becomes  continued,  and  is 
early  accompanied  by  great  irritability  of  the  stomach,  be- 
ginning with  a  vomiting  of  bilious  matter — distressing  retch- 
ing, uneasiness  and  pain  there — dull  pain  in  the  forehead, 
and  constant,  as  also  of  the  limbs — bowels  loose — continues 
thus  four  or  five  days — then  stupor — pulse  sinks — is  un- 
equal, and  scarcely  perceptible — coldness  and  dampness  of 
skin  remarkable  in  a  great  number  of  cases — tongue  dry 
and  hard,  and  teeth  and  lips  covered  with  a  dark  coloured 
fur — at  night  delirium — frequently  complains  of  pain  of  sto- 
mach, but  vomiting  now  often  ceases,  returning  frequently 
at  the  same  time  of  day — vertigo — now,  in  most  cases, 
there  comes  on  complete  coma,  muttering  delirium,  subsul- 
tus  tendinum,  and  involuntary  discharges — pulse  no  longer 
felt — in  some  cases,  a  deep  yellow  colour  of  the  skin — - 
average  duration  twelve  days — one  half  of  the  cases  died. 
In  the  early  stage  venesection  was  found  useful,  if  the  pa- 
tient told  his  complaint  in  time.     Sometimes  there  was  no 
remission — emetics  were  of  doubtful  utility.     The  disease 
was  considered  an  intermediate  type  between  yellow  fever 
and  typhus.  No  mention  is  made  of  dark  or  black  vomitings*. 

*See  Dr.  Dickson's  account  of  this  Fever,  in  Johnson,  on  the  influence  of 
Tropical  climates  upon  European  constitutions,  p.  364 — 9. 


We  might  go  on  to  enumerate  authorities  in  support  of 
our  position,  that  fevers,  in  every  respect  similar  to  that 
which  forms  the  subject  of  this  discourse,  have  repeatedly 
been  observed  in  other  parts  of  the  world. 

For  the  present  we  shall  content  ourselves  with  the  fol- 
lowing observation  : 

We  are  informed,  by  Lind,  that  the  most  frequent  and 
fatal  diseases  in  the  sickly  [wet]  season,  in  Guinea,  are  n^t 
of  an  inflammatory  nature  ;  but  generally  of  a  bilious  type, 
attended  with  a  low  fever,  sometimes  of  a  malignant,  at 
other  times,  of  a  remittent  kind.  The  pulse  was  always 
low,  and  the  brain  and  nerves  seemed  principally  affected. 
There  was  a  tendency  to  remission.  The  disease  began 
sometimes  with  a  vomiting — often  with  a  delirium,  follow- 
ed by  coma — sunken  pulse — skin  became  yellow — frequent 
bilious  vomitings  and  stools — Expired  sometimes  in  forty- 
eight  hours — generally  in  fourteen  days.  Venesection  was 
not  admissible,  but  emetics  were  used  with  benefit*. 

*  Lind  on  the  Diseases  incidental  to  Europeans  in  hot  climate?,  p.  72,  3,  S. 
8,  and  80, 


69 


PART  III. 

We  have  then  four  notable  instances  of  the  occurrence 
of  a  fever  in  our  own  country,  analogous  in  its  details  to 
that  of  Bancker-street.  Three  of  these  happened  in  this 
very  metropolis,  of  which  one  went  on  pari  passu,  at  the 
same  time  with  the  Bancker-street  fever;  and  the  other 
two  of  which  occurred  here  at  two  distinct  periods  of  time 
not  very  remote,  and  at  the  same  season  of  the  year.  The 
fourth  instance  occurred  also  at  the  same  time  and  season 
with  the  Bancker-street  fever,  and  at  the  distance  of  less 
than  one  hundred  miles  from  the  city. 

In  two  of  these  instances,  viz.  the  fever  of  the  Peniten- 
tiary in  the  suburbs  of  this  city,  and  that  brought  to  the 
alms-house  at  Philadelphia ;  the  coincidence  of  character 
was  extremely  remarkable  in  this  ;  that  they  broke  out 
simultaneously  with  the  fever  of  Bancker-street,  and  criti- 
cally resembled  this  disease  in  every  particular,  both  as  to 
the  description  of  persons  whom  they  attacked,  and  in  the 
general  concourse  of  their  symptoms. 

The  fever  at  the  penitentiary,  that  of  1 801,  and  that  des- 
cribed by  Dr.  Bard,  also  powerfully  strengthen  the  chain 
of  our  argument  in  another  respect :  for  they  not  only  ap- 
peared at  the  same  season  of  the  year,  attacked  the  same 
description  of  persons,  and  were  distinguished  by  the  same 
symptoms  with  the  Bancker-street  fever,  but  occurred  in 
the  same  locality  and  district  of  territory,  showing  thereby 
that  they  were  exposed  with  this  disease  to  the  modifying 
influences  of  the  same  soil  and  temperature.  These  three 
instances  prove  that  certain  causes  have  heretofore  existed 
in  this  locality,  capable  of  producing  the  same  form  of  ty- 
phus, at  three  distinct  and  successive  periods  of  time  not  re- 


70 

mote  from  each  other.  We  have  good  reason,  therefore,  to 
think  that  these  causes,  whatever  they  may  have  been,  were 
the  same,  and  that  they  may  continue  to  operate  also  at  fu- 
ture periods  of  time.  But  since  the  Bancker-street  fever 
so  intimately  agrees  with  these  three  several  fevers,  both 
in  its  symptoms,  the  season  at  which  it  appeared,  and  the 
description  of  persons  whom  it  attacked,  and  also  in  the 
several  circumstances  derivable  from  the  influence,  of  lo- 
cality, we  are  under  the  necessity  of  believing  that  they 
were  all  one  and  the  same  disease,  and  were  produced  by 
the  same  cause,  or  combination  of  causes. 

But  the  fever  at  the  Aims-House,  at  Philadelphia,  al- 
though it  occurred  at  the  same  season,  attacked  the  very 
same  description  of  persons,  was  distinguished  by  the  same 
symptoms,  and  went  on  like  that  of  the  Penitentiary,  simul- 
taneously with  the  fever  of  Bancker-street,  nevertheless 
differed  in  its  locality.  The  causes  connected  with  locali- 
ty or  position,  therefore,  do  not  appear  to  be  essential  in 
this  form  of  fever. 

What  then  are  those  causes  in  which  all  those  five  several 
fevers  agree,  and  which  of  them  effected  the  peculiar  phe- 
nomena in  their  character,  different  from  those  which  be- 
long to  the  ordinary  forms  of  typhus  ? 
They  all  agree  in  these  particulars. 

1.  Season  of  the  year  at  which  they  appeared. 

2.  Description  of  persons  whom  they  attacked,  viz.  the 
poorer  classes,  those  who  are  intemperate,  and  live  in  un- 
healthy and  confined  apartments. 

3.  Symptoms. 

The  secret  of  their  production  then  is  concealed  here. 
The  second  trait  they  have  in  common  with  typhus,  as  it 
appears  in  jails,  ships,  hospitals,  he.  at  all  seasons  of  the 
year,  in  summer  or  in  winter.  This,  therefore,  could  not 
have  given  the  characteristic  aspect  to  this  disease.  It  fol- 
lows, of  consequence,  that  the  season,  the  only  attribute 


71 

remaining  to  them  in  common,  besides  their  symptoms, 
must  have  given  this  disease  all  its  peculiarities.  In  all  the 
five  instances,  the  disease  was  rife  at  the  hot  season  of  the 
year,  i.  e.  in  the  last  summer  month,  and  beginning  of  Au- 
tumn. On  recurring  to  their  symptoms,  and  the  parallels 
we  have  drawn  of  common  typhus,  under  the  influence  of 
tropical  heat,  we  shall  perceive  that  the  natural  conse- 
quences resulting  from  this  peculiar  circumstance  in  the 
history  of  these  five  several  instances  of  fever,  must  have 
been  the  production  of  bilious  symptoms. 

As  the  hot  season,  therefore,  was  the  cause,  so  were  the 
bilious  symptoms  the  effect  wrought  in  this  fever,  and  the 
characteristic  feature  by  which  it  was  distinguished  from  or- 
dinary typhus. 

The  comparison  which  has  been  made  between  the  fever 
of  Bancker-street  and  yellow  fever,  in  those  points  in  which 
they  are  at  total  and  direct  variance,  shows  that  the  opi- 
nion which  maintained  their  identity,  is  utterly  fallacious, 
and  carries  on  the  face  of  it  its  own  refutation.  But  here  we 
have  had  an  additional,  collateral,  and  analogical  mode  of 
testing  the  merits  of  this  opinion,  by  comparing  the  fever 
of  Bancker-street  with  the  co-existing  fevers  in  the  Peniten- 
tiary of  this  city,  and  the  Aims-House  of  Philadelphia,  and 
with  those  which  appeared  here  in  the  year  1801,  and  dur- 
ing the  revolutionary  war. 

If  then  we  can  put  confidence  in  the  copies  given  by  their 
historians  of  these  four  several  fevers  ;  if  we  bear  in  mind 
that  the  details  of  these  diseases  do  not  come  to  us  in  a  mu- 
tilated or  garbled  state,  but  unwarped  by  controversy,  and 
unobscured  by  hypothesis ;  if  we  call  to  our  recollection 
that  their  character  has  been  presented  to  us  unembarrassed 
by  rival  or  counter  testimony,  and  that  no  person  has  ever 
contended  that  either  of  these  fevers  was  yellow  fever,  or 
other  than  some  modification  of  typhus  ;  surely  we  may  be 
allowed  to  conclude  that  they  have  been  truly  and  con- 


72 

scientiously  described,  and  are,  therefore,  what  their  his- 
torians have  represented  them  to  be,  diseases  of  a  typhoid 
type.  Whence  it  also  follows  that  the  fever  of  Bancker- 
street,  which  has  been  shown  to  bear  an  exact  resemblance 
to  these  diseases,  was  also  typhus,  and  not  yellow  fever. 


FINIS. 


JUL    21942 


